Malaria continues to be the largest public health problem globally, and its burden continues to be concentrated in the sub-Saharan African region where it is endemic. Even though there have been remarkable achievements in reducing cases and deaths due to malaria, the disease remains very much a human catastrophe. Community engagement is arguably the single most important pillar of the malaria control strategy, both in supporting and also in reinforcing interventions that reduce the incidence and prevalence of the disease. This article will argue why community engagement is key in the control of malaria and also suggest why it is central to ensuring the sustainability of the reduction of malaria.
Understanding Malaria and Its Challenges
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected Anopheles mosquitoes. It causes symptoms that range from intermittent fevers, chills, and flu-like illness to severe complications and death. Without treatment, malaria can quickly become life-threatening.
Yet decades of history with malaria control programs have shown that none of these strategies provide lasting control of malaria unless they’re supported by broad community engagement to ensure the interventions are being used properly and sustainably.
The Role of Community Engagement in Malaria Reduction
Education and Awareness
Community-led malaria control measures should begin by educating people about malaria, its transmission, and prevention methods. This education helps change behaviors and beliefs, reducing the risk of mosquito bites. When individuals understand how malaria spreads and the importance of prevention, they are more likely to adopt healthier behaviors. Communities often engage in education campaigns, workshops, and the distribution of information and educational materials to educate their members and families about the lifecycle of the mosquito that transmits malaria, how to prevent bites, and the importance of seeking rapid treatment. Local leaders and influencers can help communities better meet their needs, target the appropriate education at their level, and use culturally appropriate education methods.
Promoting Preventive Measures
This type of community engagement promotes preventive interventions, as their usage in many settings is still below the levels needed for effective community-wide protection. Although indoor residual spraying (IRS) and insecticide-treated nets (ITNs) are relatively affordable, they remain underused due to a lack of awareness about their benefits and the presence of misconceptions. Promoting their use by engaging community members typically increases uptake levels. For example, Chieng Filimao and his wife, who brought him to the hospital in Malawi despite his refusal to go, are developing training programs to increase the usage of long-lasting insecticide-treated bednets (ITNs). Community health workers will educate families about the correct use and maintenance of ITNs, as well as common misconceptions.
Encouraging Timely Treatment
Access to early, high-quality treatment is essential for controlling malaria. Community engagement plays a vital role in combating malaria. When people are motivated to visit health facilities at the first sign of symptoms, community health workers and leaders can quickly diagnose the disease and deliver timely treatment.
Strengthening Health Systems
Community participation here can enable improved resilience in local health systems themselves. To support local control efforts, communities can identify gaps in health systems and advocate for essential improvements. This includes ensuring that health facilities are equipped with the necessary resources and trained staff, maintaining a sufficient supply of antimalarial drugs, and establishing a reliable supply chain for their delivery.
Building Trust and Collaboration
Trust is an integral component of malaria control programs if they are to be successful. By engaging with the community, local authorities, and other key stakeholders, community participation in malaria reduction ensures local investment of time, effort, and support critical for better outcomes.
Addressing Social and Cultural Barriers
Every community has its demographics, challenges, and cultural and social norms, which can influence health behavior. Working with local leaders and organizations for community engagement identifies these barriers and empowers programs to plan interventions or modify existing ones to overcome the obstacles. For instance, putting life vests on children might appear as an unnecessary burden when there is no river around. But this action would make a life-saving difference to children in coastal areas, as demonstrated during the Boxing Day tsunami in 2004. In Malawi, by working with local chiefs, a Counterfeit Medicines Campaign was designed and executed that could adapt to the norms and values of the community and was not perceived as a violation of traditional practices. It attracted the involvement of traditional healers who normally discourage the use of ‘chemical’ drugs. This approach was able to increase the acceptance and, by extension, the effectiveness of malaria control.
Empowering Local Leaders
A key element of community engagement is training and involving local leaders. Local leaders in communities (eg, traditional leaders, religious leaders, and community activists) can have a substantial influence on community attitudes and behavior, and training and involving them in malaria programs can increase their reach and effectiveness. As advocates for malaria prevention, and providers of information, local leaders are also capable of mobilizing the community’s resources.
Case Studies of Successful Community Engagement
The Roll Back Malaria Partnership
Community engagement is another promising avenue. We know that it works in reducing malaria because the Roll Back Malaria (RBM) Partnership has been using it for years. This global partnership with member countries, international organizations, nongovernmental organizations, research institutes, and the private sector fosters collaboration in countries to control and eventually eliminate malaria. It strengthens malaria control programs at the local community level by training community health workers and engaging communities in malaria control activities. In many countries, RBM has teamed up with local organizations to promote the use of ITNs and other control measures and set up systems for early treatment. In total, it has helped to reduce malaria mortality by 42 percent and the number of new malaria cases by 37 percent.
The Malaria Consortium’s Community Case Management Program
A more established example of effective community engagement is the Malaria Consortium’s Community Case Management (CCM) program. The program trains community health workers to diagnose and treat uncomplicated cases of childhood malaria outside health facilities. Launched in 2009, the Malaria Consortium’s CCM program has rolled out in remote locations across multiple countries in Africa and Asia, including Uganda and Nigeria.
The “Zero Malaria Starts with Me” Campaign
The African regional ‘Zero Malaria Starts with Me’ campaign – dubbed ‘the most successful behavior-change campaign on the continent’ – has used community engagement to energize everyone in a community, seeking to empower individuals to be part of the malaria world. The campaign enlisted local and national leaders, celebrities, and ordinary citizens to increase awareness and trigger action on malaria prevention and control in communities. It spread rapidly across the continent and now the campaign boasts 125 million campaign ambassadors who have rekindled traditional policies to improve hygiene and ensure risk reduction through methods such as net-hanging.
Strategies for Enhancing Community Engagement
Building Partnerships
Cultivating strategic partnerships with local counterparts such as NGOs, governments, and community leaders can build consensus and ensure successful public health outcomes. Such partnerships can also lead to the identification of critical linkages with community members, such as religious and community leaders. Together, the cooperation of health officers, volunteers, and socially responsible entities such as businesses and civil society organizations is a powerful force against malaria, enhancing the capacity of local health systems to administer and promote malaria prevention. This strategy roots malaria interventions in the cultural system, increasing the likelihood of widespread adoption of various prevention methods. By aligning with local practices and beliefs, these interventions become more relatable and effective within the community.
Utilizing Media and Technology
There are many ways to engage communities through media and communication technology to reach as many people as possible. Radio, television, and social media can be used to spread information about malaria prevention and treatment. In the digital age, we can connect and engage with communities through mobile apps and application programming interfaces (APIs).
Training and Capacity Building
All of this requires building capacity – training community health workers and local leaders; ongoing education and support to keep them motivated; feeding back data and stories about the value of their work; and equipping the community with the necessary tools and knowledge to contribute to malaria control.
Monitoring and Evaluation
Logging frequent impact reports through continuous monitoring and evaluation of any community engagement activity assists in tracking the level and direction of desired attitude change of the community. Feedback from stakeholders such as individual community members or long-term community members, CBOs, government stakeholders, etc will help clinicians to understand the efficacy of their interventions and to make appropriate efforts in the right direction.
Encouraging Community Ownership
When communities own the planning, implementation, and evaluation of a malaria control campaign, they are more likely to take the lead in ensuring its continued use and momentum over time.
To achieve this objective and ensure the sustainability of malaria reductions, community engagement is paramount and remains one of the four pillars of the WHO global technical strategy for malaria (2016–2030). In particular, effective multisectoral partnerships with the community for malaria control hinge on educating communities about the disease, promoting prevention measures, facilitating timely treatment-seeking, and identifying and resolving social, behavioral, and cultural barriers to success. Moreover, various examples from different countries suggest that progress toward achieving malaria elimination is contingent upon the inclusion of local stakeholders and the establishment of strong partnerships. Thus, fostering these connections is essential for effective malaria control efforts.
In this dynamic struggle, investment in community engagement will continue to be important. By harnessing collective labor and keeping involvement high throughout malaria prevention and control processes, we can help to decrease the burden of the disease, and foster resilient, healthier communities.
