Image: Health care workers in the Home Management of Malaria program, East New Britain, PNG.
Community engagement is a vital but often overlooked aspect of many malaria elimination programs.
Burnet Deputy Program Director, Behaviours and Health Risks, Ms Lisa Davidson addressed the 1st Malaria World Congress in Melbourne, telling delegates that without community engagement, support and empowerment, malaria will not be eliminated.
“Past history shows us that any country that has successfully eliminated malaria did so with the full support and engagement of government and communities,” she said.
“It doesn’t matter how good your diagnostic tests are, how good your medicines are, how good your surveillance system is - if you don’t have your community on board you’re not going to eliminate malaria.”
She told the story of a two-year Burnet program in East New Britain (ENB), an island north of mainland Papua New Guinea (PNG), which successfully trained volunteers to test and treat malaria in their own community, and which dramatically reduced prevalence.
“The 2012 SPAR, (the Sector Performance Annual Review by the PNG Health Department), reported that over 50 per cent of childhood illnesses in ENB were attributed to malaria and 70 per cent of all hospitalisations were as a result of or complication of malaria,” she said.
“When communities were consulted they overwhelmingly identified malaria as the major health issue.”
Image: A community volunteer in East New Britain.
Volunteers test and treat
The Home-based Management of Malaria program trained volunteers to test and treat malaria in their villages, following a simple algorithm to take a history, test for fever and perform a rapid diagnostic test for malaria.
This ensured patients with malaria were diagnosed and treated quickly, and reduced severity and transmission. In an area where any fever had been assumed to be malaria, it meant people with other fever-related issues began to get a correct diagnosis, instead of carrying chronic untreated infections and being wrongly treated for malaria.
It meant stories like this, of a mother and baby’s two-day journey on foot to reach malaria diagnosis and treatment, did not need to happen.
“It reduced the burden of care at health facilities and meant communities also became more involved in prevention activities. Bed-net use increased, mosquito breeding sites were identified and removed.”
Over the 24 months of the program’s life, incidence and severity of malaria infection was dramatically reduced, providing a vivid illustration of the benefits of a community engagement model.
Image: Malaria Management at Home volunteers in East New Britain, PNG.
A need for long-term funding to reach elimination
Sadly, the program also illustrated the drawbacks of short term funding when it comes to malaria elimination. The dramatic reduction in malaria meant donor funding was reallocated and community interest refocused to illnesses with greater impact.
Community volunteers were no longer supported and 12 months after the program’s closure, the prevalence of malaria had returned to pre-program levels.
“If you have continued funding over a 10-year period, elimination becomes possible. But when you’re only funded for two years or three years, all you’re doing is getting the prevalence down a bit and then funders say good job, now we’re going to go onto some other disease, so you’ll never get to elimination,” Ms Davidson said.
“It also means children born during the project weren’t exposed to malaria because the disease was reduced, so when they are exposed to malaria for the first time they are two or three, and they’ll be sicker than if they were exposed as a baby.
“It’s really frustrating and it’s really sad for the communities because they were really on board and making a difference. It makes them lose faith and it makes it harder to re-engage them later on.”
However she said the program had played an important role in proving the feasibility of a model that used community-based volunteers.
Burnet is proudly supporting the 1st Malaria World Congress in Melbourne from 1-5 July featuring experts across research, policy, public health, international development and advocacy focused on eliminating malaria.