MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

TABLE 14: COMMUNITY ACTIVITIES FOR A MALARIA ELIMINATION
PROGRAM
Objective Activity (Elimination Program)
Encourage appropriate
health-seeking behavior
of caregivers, family, and
community by improving
the recognition of
malarial illness (including
severe illness) and
the decision to seek
appropriate treatment
within 24 hours of onset
of illness
Strengthen the capacity
of health systems,
particularly at community
level, including access to
antimalarial drugs and
referral mechanisms
Improve access to
insecticide-treated nets,
and promote their
regular and proper use.
Promote and increase
acceptance levels for
vector control, including
IRS and environmental
management wherever
appropriate
Strengthen community
self-monitoring and
decision-making
Build community and
local political support
for the goal of national
malaria elimination and
urge leaders to maintain
it as a political priority
Use survey results (DHS, MICS) to identify areas
and/or specific groups that have lower rates of
health seeking for fever. Evaluate reasons for not
seeking health care for fever in collaboration with
the community (focus groups discussions) and
identify potential solutions.
Aggressive IEC/BCC activities with strong
community participation and buy-in from
community leaders at all levels. Community
participation can be achieved by using existing
grass-root organizations such as women
associations, youth groups etc…
Involve the community in the management and
M&E of the local public health facilities through
local health committees
Involve the community in the planning and
execution of LLIN distribution campaigns.
Use post-campaign surveys to evaluate usage and
reasons for non-usage. Evaluate these reasons in
collaboration with the community and identify
potential solutions.
Continuous IEC/BCC, stressing the fact that LLIN
usage needs to remain high even in the absence of
the disease to protect both the individual and the
community as a whole.
Involve the community in the planning and
execution of IRS campaigns.
Document any refusal and invite people who
refused to focus group discussion to understand
the reasons behind refusal and to find potential
solutions.
Continuous IEC/BCC on the importance of
preventive measures for a disease that is rare.
Ensure community participation (observers for
example) during surveys and/or supervision both
at the health facility and for campaigns.
Provide feedback to the community and discuss
reasons for success or failure.
Involve the community in any major changes in
strategy through stakeholder meetings both at
the district and the central level.
High level political involvement in malaria
elimination advocacy to ensure that malaria
elimination becomes a matter of national pride
In Zanzibar, the above-proposed SHCC can be used to involve
the community in malaria elimination. Community involvement
will be more relevant for activities that require either individual
action (using an LLIN) or acceptance to provide a sample (active
case detection) or allow people inside private premises (IRS). For
these activities, the health services and its partners could introduce
in a participatory manner (SHCC meetings) the range of possible
intervention(s), and the means by which the community can
actively contribute both in the planning and implementation
to ensure community ownership from the onset. The following
roles of community and health services/partners (Table 15) are
adapted from the previous CDI study (WHO/TDR, 2008) and
applied to pro-active case detection, a key activity proposed by
the technical working group to achieve and maintain elimination.
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TABLE 15: COMMUNITY ACTIVITIES FOR A MALARIA ELIMINATION
PROGRAM
Role of the health service/partners Role of the community
Explain the rationale behind
pro-active case detection to the
community in the SHCC meetings.
Explain the different strategies/
activities that can be used for
pro-active case detection.
Offer technical support (training/
equipment) to allow the community
to actively participate in the
pro-active case detection activities.
Explain the indicators used for the
evaluation of the activities related to
pro-active case detection.
Provide feedback on the results of
pro-active case detection and the
strengths/weaknesses of the activities/
strategies used.
Apart from the SHCC, other community groups such as youth
groups, women’s associations, sports clubs, and cultural groups,
can be valuable partners for community-directed malaria
elimination activities. In addition, traditional birth attendants
and traditional healers play an important role and are often the
first level when it comes to health seeking behavior. Buy-in from
both groups will therefore be a key determinant for the success of
malaria elimination, especially related to advice on appropriate
health seeking behavior for people with fever. As pointed out
above, they should be provided with the necessary technical
assistance to fully take advantage of their contribution. Behavior
change, both in terms of health seeking behavior and adherence
to preventive activities, can also be promoted in schools by
including relevant messages on malaria in the curriculum.
RECOMMENDATIONS
Use community knowledge to
identify areas of high risk for malaria
transmission (know breeding sites) to
be targeted for active case detection.
Evaluate the level of acceptance
by discussing these strategies/
activities with community members
in the SHCC meetings and propose
solutions to potential bottlenecks.
Identify resources available in the
community and define roles and
responsibilities in collaboration with
the health service and other partners.
Identify key resource people in the
community that can participate
in supervision activities and data
collection.
Discuss the results and find solutions
to identified bottlenecks.
�� The results of the different community surveys should be used
to identify areas that require community level interventions
and participation. Reasons for not seeking care for fever, for
example, should be thoroughly analyzed and addressed in
collaboration with the community.
�� LLIN and IRS campaigns should systematically evaluate
reasons for non-usage and refusal rates, respectively.
Community-level focus group discussions can be used to
better understand the reasons behind non-usage or refusal
and to identify potential solutions.
�� Aggressive IEC/BCC, with strategies and methods adapted
to the Zanzibar context, should continuously repeat the
need to have all fever cases tested and to keep coverage/
usage for personal protection high. In addition, IEC/BCC
campaigns should also be used to explain why certain malaria
elimination-specific activities such as case investigations are
important and how they can benefit the community.