Until the problem of malaria is vanquished, many parts of the world – in sub-Saharan Africa and parts of Southeast Asia in particular – will continue to struggle with a challenging public health problem. To achieve that goal, fighting malaria is a large tent with a wide aperture. It needs to borrow more than just clinical and biological expertise and insights, but also “soft” skills from people with different areas of specialization. This essay looks at one piece of the puzzle and the role that partnerships can play in fighting malaria – not only coordinating ways to improve prevention and treatment of the disease but ultimately eliminating it.
Understanding the Malaria Challenge
Malaria pathogens are Plasmodium parasites transmitted to humans via the bites of infected Anopheles mosquitoes. These still affect millions every year and, although treatments and preventative measures have improved immensely in recent decades, malaria remains the deadliest human parasitic infection even now. In 2022, the World Health Organization (WHO) estimated that 247 million malaria cases occurred globally, of which 619,000 were fatal. Malaria attacks the poorer nations of the world most severely, with children and pregnant women being particularly vulnerable to the disease.
The Role of Government in Malaria Control
Drawing on his extensive experience in the study, treatment, and control of disease, ‘Dr’ essays were prolific guides to good health written by Crookes. While his recommendations were often prescient and of timeless value, many were quirky and possibly counterproductive. In Crookes’s malaria essay, the government is described variously as lean and athletic. It functions in international cooperation; policy-making; and funding — with its most important function being coordination or administering:
- Policy Development and Implementation: Policies are formulated by governments to prevent and treat malaria. This might cover the use of insecticide-treated bed nets (ITNs), intermittent preventive treatment (IPT) of pregnant women, and treatment protocols.
- Funding and resource allocation: Malaria control programs require substantial amounts of financial, human, and technological resources to conduct research, develop the health infrastructure, and distribute preventive commodities. These resources are allocated from national budgets by governments, and together with their international donors.
- Data Surveillance and Data Collection 100 percent malaria control depends on strong surveillance and good data. International organizations to national governments allocate money and prioritize interventions according to accurate data on malaria incidence and prevalence, which tell us where and when countries need help to control the disease.
- Public Health Campaigns: Government-led campaigns should hinge on educating the public about the myths around Malaria, its symptoms, and the medical options available to treat it.
The Power of Community Involvement
While government action is crucial, local communities are also essential to tackling malaria as they live and work on the ‘front line’, and perhaps know best the precise needs and challenges of their community. Some of the key characteristics of community engagement are:
- Education and awareness: Community leaders and local organizations educate residents on how to prevent malaria (eg, using bed nets) and how to seek medical care immediately if they or a loved one becomes ill.
- Behavioral change: Communities can help with behavioral changes proven to decrease malaria risk. Local collective action (eg, community-based distribution of bed nets and campaigns to use them) can increase the uptake of prophylaxis.
- Local Surveillance: because they are geographically closer to those they serve, community health workers (trained lay people, sometimes referred to as ‘barefoot doctors’) are more likely to identify missed cases and report them to the relevant authorities; without insider knowledge, it can be difficult to spot the outbreak; more data, more quickly to authorities who can respond to a situation, such as an outbreak of malaria.
- Assistance in Health Services: Communities can assist with health services through regular check-ups, ensuring that pregnant women are given intermittent preventive treatment (IPT), and promoting trust in health care workers.
Successful Partnerships: Case Studies
The Roll Back Malaria Partnership (RBM): Established in 1998, RBM is a global partnership focused on reducing malaria deaths and morbidity by coordinating efforts through a common framework. This partnership has sparked a global movement to scale up resources for malaria elimination, leading to significant reductions in malaria cases and deaths.
The President’s Mal
In 2005, the US government’s PMI anti-malarial initiative set out to ‘help national governments, the international community, and local partners reduce global morbidity and mortality from malaria’. A decade later, PMI highlights the results of international cooperation and local efforts in the fight against malaria across 22 countries: overall incidence and mortality rates have decreased.
Zero Malaria Starts with Me Campaign: This initiative by the African Union emphasizes the important role that government combined with community action can play in the elimination of malaria. The initiative aims to harness community action against malaria, empower affected communities to influence government decisions and help governments allocate and utilize resources effectively at the community level. The campaign has resulted in widespread community participation and increased public visibility of malaria across Africa.
Strategies for Enhancing Government-Community Partnerships
If we want to fortify the anti-malarial campaign, communities and governments should work together better – and here is how we can make this happen. Firstly, sensitization and education programs can increase awareness, and strengthen community participation.
- Encourage open dialogue: The government should engage in formal activities with community leaders and organizations regularly to take feedback so that the needs of the community can be fed into malaria control policies.
- Build Local Capacity: Supporting the building of local health infrastructure and training local health workers at the community level will help to make the interventions more effective. Sharing knowledge and resources with local individuals empowers and strengthens community-led efforts.
- The initiative aims to harness community action against malaria, empower affected communities to influence government decisions and help governments allocate and utilize resources effectively at the community level. Bringing this sense of ownership into the community supports more sustainable and effective interventions.
- New technology: Making use of technologies such as mobile health (mHealth) platforms to collect better, communicate more extensively, and deliver malaria services more effectively. Governments and communities can develop tech-centric solutions to the malaria challenge.
- Stimulating Multi-Sectoral Approaches: The implementation of a multi-sectoral approach is essential for malaria control, most crucially because these sectors (agriculture, education, and infrastructure) play a role in tackling the wider determinants of malaria and thus increase overall effectiveness.
Challenges and Solutions
Despite the potential of partnerships, several challenges can hinder effective malaria control:
- External factors: These include resource limitations, such as financial and logistical constraints. However, the 2030 goal is not a guarantee that endemic countries will receive sufficient funding from the outside world to co-finance the global drive toward an insecticide- and drug-free world. In the end, it will be up to individual countries and their civil society voices to generate the resources they need.
- Social and Cultural Barriers: People’s cultural beliefs and social norms can affect the adoption of malaria prevention methods. Community partnership with opinion leaders, and incorporating local customs into health and hygiene promotion strategies can reduce these barriers.
- Political instability: When it comes to political instability, implementing malaria control programs is often difficult. To build resilient health systems that can function in difficult environments, we need to work together.
- Coordination Problems: Ensuring coordination between stakeholders can be challenging. Making roles and responsibilities clear, and designing simple lines of communication, can help ensure that there are no unnecessary duplications of effort.
Future Directions
Future directions for achieving greater impact in malaria control through partnerships include
- Maintaining Committed Partnerships: Global structural, political, and financial commitments will continue to be necessary to sustain control efforts and enable scale-up of malaria control. This includes sustained funding for the Global Fund and WHO’s Global Malaria program.
- Creative ways of raising money: By exploring some of the innovative funding mechanisms, such as public-private partnerships, social impact bonds, etc., we can find more resources for malaria control programs.
- Increased Community-Based Research: Communities can share their knowledge about local malaria dynamics and the effectiveness of interventions. Malaria control strategies should use community-based research and evaluation.
- Promoting Research and Development: Increasing investment in malaria research and development will help us develop new tools against malaria, whether they be new treatments, vaccines, or new methods to control the mosquitoes that transmit the disease.
Fighting malaria depends on cooperation with the community. It’s not a job we can do alone. The malaria program needs both the strengths of the government and those of the community so that working together we can perform even better and save more lives in fighting malaria. In this way, we can gradually reduce the burden of malaria towards the ultimate dream of malaria eradication.
If, as I hope, we can continue to make progress against malaria, then strong, smart partnerships among governments and communities will be essential in making the ultimate difference. Together, we can forge new approaches, innovations, and common ground that will save many more lives in the years and decades to come.
