Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

Cross Border Malaria Initiative Round Table meeting held in Zambia

11 April 2019

On February 28th and March 1st, 2019 malaria partners joined together at the Isdell:Flowers Cross Border Malaria Initiative Round Table meeting, hosted by the J.C. Flowers Foundation. The Isdell:Flowers Cross Border Malaria Initiative partners with national governments, the Anglican Church, NGOs, and community members to eliminate malaria along the shared borders of Angola, Namibia, Zambia and Zimbabwe. Focusing on community engagement, the Round Table prominently displayed the 2019 World Malaria Day theme “Zero Malaria Starts With Me,” in recognition that each and every person—from bishop to community organizer to researcher to mother—has a key role in malaria elimination.

Zambian Minister of Health, The Honourable Dr. Chitalu Chilufya, formally opened the Round Table by stressing the importance of involving communities in the elimination process. “We will not have success in universal health coverage without eliminating malaria,” he said, “and we will not have success in eliminating malaria if we do not engage effectively with the community.”

Proven strategies for malaria elimination, such as bed nets, indoor residual spraying, case management, and surveillance hinge on the adoption of very specific behaviors by the communities they target. Unless individuals perceive malaria as a threat and believe their behaviors can contribute to eliminating malaria, the strategies will fail to realize their full potential. However, if communities feel a sense of ownership, these activities will be easier to implement and coverage targets required for malaria elimination will more likely be reached.

Participants at the Round Table discussed different means of engaging communities in different transmission settings. Important tools for community ownership include COCEMAs (“Community Malaria Elimination Committees”), which the Isdell:Flowers Malaria Initiative has been facilitating in Southern Angola. These committees are made up of 8-12 community leaders, who oversee community malaria elimination activities and resolve barriers to elimination. They serve as a bridge between community and the Government Health Department, and support and manage all community volunteers. Through COCEMAs, leadership is transferred to the hands of those living with malaria.

The MEI’s own Roly Gosling spoke at the meeting, emphasizing that reducing malaria to zero needs to happen at the district level, with two-way communication and collaboration with the communities they serve. Gosling reported on an MEI initiative in Southern Africa that aims to bridge the gap between district-level decisions and the community.

The Organizational Development for Malaria Elimination (ODME) tool aims to improve service delivery of malaria interventions at the lowest level of implementation: the district, including health facilities, and also environmental health officers and the communities they serve. Currently being implemented in Matabeleland South with support from the J.C. Flowers Foundation, the Organizational Development for Malaria Elimination process has been developed in response to “one-size-fits-all” strategies that are too often applied, and aims to respond to the reality that most barriers to elimination are not technical but rather operational in nature.

It has shown improvement of malaria control and elimination activities (demonstrated by improved reporting of cases; improved coverage of interventions including indoor residual spraying coverage, case investigation, case management and more), and improvement in general health services (demonstrated by improved problem identification and solution finding at district and regional levels; improved staff motivation).

Community engagement can be thought of as a spectrum. On the lowest end of community support, communities could disallow interventions to take place, such as refusal of IRS. Slightly more engaged communities could display passive acceptance, while further engaged communities put forth effort to support interventions (i.e. participate in mass test and treat campaigns). On the highest end of community engagement is ownership, where communities are active in finding solutions and are partners in the elimination process. Empowering communities to take ownership of elimination is the goal.

“There seems to be a misunderstanding of the term of community engagement,” Gosling said. “[Community engagement] is not just community health workers, and it’s not just telling people what we’re going to do. It is about having a discussion with the community to discover what the problems are, and then building your intervention around those community-directed problems.”

Round Table participants, in addition to those mentioned above, included Dr. Richard Kamwi, Elimination 8 Ambassador; Anglican Bishops from the Dioceses of Zambia, Angola, Namibia, and Matabeleland; King Mario Satipamba, King of the Onaluheke Kingdom in Angola; Chief Mundandwe of the Mishilundu Chiefdom in Liuwa Plain National Park; representatives from the United States Agency for International Development’s President’s Malaria Initiative, The RBM Partnership, the Harvard T.H. Chan School of Public Health, The MENTOR Initiative, Malaria No More, United Kingdom; Johns Hopkins Center for Communication Programs, MACEPA, Macha Research Trust, and BASF.