Mozambique is a colorful and diverse country in south-eastern Africa, home to more than 30 million people. Malaria is a persistent public health problem in Mozambique. The disease is caused by protozoan parasites of the Plasmodium species, most commonly the P falciparum and P vivax species, which are transmitted through the bites of infected Anopheles mosquitoes. In Mozambique, malaria continues to be a leading cause of morbidity and mortality. In light of this challenge, Mozambique has developed and implemented a multifaceted malaria surveillance approach. Community engagement is an integral part of Mozambique’s surveillance programs.
Understanding Malaria in Mozambique
Mozambique has high malaria transmission, especially in rural and semi-urban settings, and according to the World Health Organization (WHO) is among the world’s highest-reporting countries for malaria. The disease represents a huge burden on the health system and economy, with thousands of cases reported each year.
Finland became proud that Malawi was the first independent country in Africa to achieve such results, and the current president of the Mozambique Parliament, Alda Auro Costa, paid tribute to them. As part of the strategy, including the distribution of insecticide-treated bed nets, indoor residual spraying, and anti-malarial medication, the Mozambique government worked with international organizations, non-governmental organizations (NGOs), and, importantly, the communities were involved in malaria surveillance a practice that has played a critical role in reducing malaria incidence scores and deaths.
The Role of Community Engagement in Malaria Surveillance
Community engagement builds local capacity by actively engaging local communities and enabling them to participate in the planning, implementation, and evaluation of interventions. For malaria surveillance, this means that communities become actively involved in the detection, reporting, and management of malaria. Here is how it works in Mozambique:
1. Enhancing Early Detection
Early detection of new cases allows for their treatment and helps prevent the spread of disease. In the event of a malaria outbreak, Mozambique has community health workers (CHWs) working as detection agents. The 26,000 CHWs, recruited and trained from within their communities, contribute to the identification of malaria cases by recognizing symptoms and referring suspects for testing.
Most importantly if CHWs are locals, they will be aware of malaria cases within their community at an early stage. Beyond this, the local understanding of health challenges, culturally sensitive approaches that are acceptable to the community, as well as language barriers, are all factors that local workers are likely to be better positioned to identify and report malaria cases accurately and promptly. Moreover, CHWs can bridge the communication gap between healthcare providers and local communities; they are likely to be able to communicate more effectively with sick individuals and those who are at risk while instilling trust in the local healthcare infrastructure.
2. Promoting Health Education and Awareness
Prevention mantra: education and awareness are key because you cannot tackle transmission without community engagement to educate about causes, symptoms, prevention, and treatment. The National Malaria Control Programme in Mozambique actively promotes these messages across the country. People learn how to use insecticide-treated bed nets, participate in home-based indoor residual spraying, and access prompt medical treatment for suspected malaria.
To spread this message, community meetings, workshops, and home visits serve as effective options. Local cartoonists, witch doctors, schoolteachers, and church schools often contribute to these educational campaigns, providing accurate information and debunking myths about malaria.
3. Encouraging Community Participation in Malaria Control Activities
People in local communities must be actively involved in operations against malaria. Throughout Mozambique, local people are regularly consulted about the use of indoor spraying, and the distribution of bed nets, and participate in mechanisms for community-based surveillance.
For instance, some communities have organized malaria days, when the community assembles to clean up, remove mosquito breeding sites, and receive malaria prevention equipment and information. Such community-led interventions both assist in malaria control and increase community buy-in, so that community members are more responsible and involved.
4. Strengthening Data Collection and Reporting
Reliable data collection and reporting can track malaria trends and identify where to target resources. Since the quality and quantity of data are critical, engaging with communities has become an essential part of the process. Local volunteers and health workers can easily report aspects such as case incidence, treatment outcomes, and control activities to health authorities, guiding malaria control interventions.
In some areas, community-based surveillance systems mobilize the use of mHealth tools for real-time case reporting. These systems not only strengthen the capacity of community health workers (CHWs) and community members to report cases and outbreaks promptly to health authorities but also generate essential information needed to control and eventually eliminate the disease.
5. Addressing Barriers to Access and Utilization of Services
For example, improving malaria control usually depends on getting as many people as possible to use available health services. By talking to community members and identifying their fears, cultural beliefs, and difficulties, we can break down some of the barriers that keep people from using malaria prevention and treatment services. These include the high costs of traditional care, geographic isolation, and fear of substandard facilities.
Community health workers and lay leaders can overcome this challenge by supporting and advocating for access to services. They help bring health interventions to those in need through mobile clinics or outreach programs run by community-based organizations.
Case Studies of Successful Community Engagement in Mozambique
Mozambique recently demonstrated several efforts to harness the power of community involvement in malaria surveillance and control:
1. The Malaria Elimination Initiative (MEI)
The Malaria Elimination Initiative is a large-scale collaboration between the Foundation and the Mozambique Ministry of Health aimed at reducing malaria transmission to a level where it can be eliminated. Community involvement plays a crucial role in this effort. Trained community health workers, leaders, and volunteers conduct home testing and treatment for malaria and educate others on prevention methods.
Malaria incidence has dropped in the areas where the initiative is active, and malaria case detection and treatment have improved significantly as a direct result of involving communities in these efforts.
2. The Vector Control Program
The Vector Control Program is responsible for reducing the population of mosquitos through environmental management and, if necessary, with the use of insecticides. Both of these activities depend on the involvement of the local community. Members of the local community play roles, such as identifying breeding places and eliminating mosquito habitats, applying insecticides at identified spots, and reporting any mosquito breeding hotspots.
The program has effectively decreased malaria transmission in communities where it is implemented. In particular, medics involved in the program have successfully maintained low malaria incidence for two to three years after implementation, thanks to the active participation of community members. As a result, this engagement has sustained vector control and kept malaria rates in check.
Challenges and Future Directions
Community engagement in surveillance for malaria eventually succeeded, but not without learning several lessons. Here are some of the challenges:
- Sustainability of Engagement: The main challenge of community-based surveillance is maintaining long-term commitment from community members and health workers.
- Cultural and Social Barriers: Ongoing and sensitive dialogue is essential to address cultural beliefs and practices that can impede malaria prevention and treatment.
- Constraints: Resources – Community-based interventions are dependent on resources, both human and economic. It is essential to ensure adequate funding and support for community engagement activities.
- Looking ahead, there are several opportunities to strengthen community engagement in malaria surveillance:
- Scaling Up Training Programmes: Increase the numbers and capacity of CHWs through improved training and support, thus enabling more vigorous approaches to surveillance and response.
- Use of Existing Technology: Using technological tools and infrastructure that already exist can be a useful way to build on existing resources for collecting, reporting, and communication between communities and health authorities.
- Deepening Partnerships: Working with community-based organizations, non-governmental organizations, and other international partners can help to scale up initiatives that have shown good practices in community engagement and learn from one another.
Community participation is a key component of Mozambique’s malaria surveillance strategy. Specifically, by engaging local communities in the surveillance of mosquitoes, the detection and reporting of fevers, active case detection, and the fumigation of houses, Mozambicans have effectively battled the burden of malaria.
Moreover, Mozambique’s success in controlling malaria and its commitment to elimination will serve as a model for other countries facing similar challenges. In essence, it demonstrates how to sustainably engage communities in the fight against malaria.
