For me, it is personal. When I was 3 or 4, I lost my mother to malaria. I don’t remember exactly, because I have no memory of her, just stories passed down from my relatives about how she was sick. At that time, there were no health services in the small town where I was raised in Ethiopia to treat her malaria.
Because of my personal experience, I have grown very passionate about malaria control: I once fed African mosquitos with my own blood to study them for my doctoral research at Harvard University. While more resources are needed to fight this disease, which disproportionally kills young children and pregnant women, resources alone are not enough. To mount our best offense in the fight against malaria, we must fully engage the communities where we work and ensure that the health systems that we have in place are strong so that the gains we make in malaria prevention are sustainable.
In my home country of Ethiopia, I lead a project funded by the U.S. Agency for International Development under the President’s Malaria Initiative to reduce the burden and then eliminate malaria through indoor residual spraying, or IRS, operations which kill mosquitos that transmit malaria by spraying insecticide on the walls of homes. We are empowering communities to prevent malaria by tapping into the existing government infrastructure and health workers at zonal and district health offices, as well as a strong network of 30,000 health extension workers who help deliver primary care in even the most rural villages.
I am also involved in a pilot project to test how we can further decentralize efforts to the community level to eliminate malaria through spraying. We mobilize government health extension workers, who are permanently based at village health posts, to help people understand how spraying will protect them and their families from malaria and the ways they can prepare their houses for a successful spray campaign. With support from our team, health extension workers train spray operators, manage day-to-day implementation and supervise spray operations.
We found that health extension workers who were in the community were able to carry out this work in a way that was faster, better and more cost-effective. The community-based model saved approximately 10 percent more than district-based IRS in 2012, and is estimated to cost 40 percent less the next year, in part because it reduces transportation costs. And since spray operators lived in the community, the system allowed for rapid mobilization of workers in the case of an unexpected malaria outbreak. Recruiting spray operators from their own village also meant they were more likely to feel a strong sense of ownership in the process, and the prevention efforts were more likely to be accepted in the community.
Our pilot project shows that community-based health systems can be effectively utilized to implement community-based IRS and ensure that we can do more to fight malaria with limited resources. To me, a stronger community-based health system means taking most of the basic malaria prevention and control services closer to the community and households, including people living in remote areas. Strong community-based health system can be used to:
Effectively organize and implement IRS at the community level.
Distribute insecticide treated nets to the needy and at the right time.
Provide malaria diagnosis using simple rapid diagnostic methods at the community and household level.
Provide prompt and early treatment and save the lives of children mothers.
Refer severe cases to health facilities that are equipped to handle them.
Educate communities to make them understand the benefits of IRS, use of nets and seeking malaria treatment promptly.
While progress is being made against this deadly disease, on this World Malaria Day, I remember all of the people whose lives were cut short – including my mother’s – and I strengthen my resolve to make a difference. Knowing I am working with a team that greatly contributes to protecting people from getting sick and dying of malaria makes my day-to-day work rewarding.
To fully wage our battle against malaria, creating strong community health systems and building the capacity of these health systems to engage communities in malaria control and prevention will be essential to creating a lasting impact. I don’t believe there are quick fixes and solutions to malaria prevention and elimination. It is going to take some time. Sustained and coordinated efforts are crucial, and strong community-based health systems are essential to do more with limited resources and make programs more resilient and sustainable.
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