Shrinking the Malaria Map

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

Isdell:Flowers Cross Border Malaria Initiative Round Table focuses on malaria elimination

25 March 2020

MEI Director Roly Gosling speaking at the Isdell:Flowers Cross Border Malaria Initiative Round Table

Partners in malaria elimination joined together in Livingstone, Zambia on February 27th and 28th, 2020 at the Isdell:Flowers Cross Border Malaria Initiative Round Table, hosted by the J.C. Flowers Foundation. The Round Table brought together faith leaders, traditional leaders, government officials and national malaria program staff, academics, international partners, and front-line workers to discuss the important role of malaria-affected communities in the fight against malaria and ensuring they are a central component of malaria elimination strategies.

The opening remarks by His Royal Highness Chief Chamuka (Chief of the Lenje people of Chisamba, Zambia) introduced attendees to the theme of the Round Table, “Zero Malaria Starts With Me: Engaging My Community,” which calls on every one of us to play a part in the fight against malaria. “It is not the role of Isdell:Flowers alone, it is not the role of government alone, it is not the role of other stakeholders alone, but the chiefs must also give whatever little resources we have to our people,” he said. “Malaria elimination begins with me, and indeed, it starts with you as well.”

1,700 community malaria volunteers who are part of the Isdell:Flowers Cross Border Malaria Initiative provide malaria education, testing, and treatment along the shared borders of Angola, Namibia, Zambia, and Zimbabwe. Gilbert Chilala, a community health worker from Kazungula, Zambia, came to the Round Table to share his experience working on the front lines of malaria elimination. He explained how religious and traditional leaders in Kazungula managed to convince community members to accept malaria blood tests, despite initial community suspicions associated with finger pricking.

Roly Gosling, Director of the UCSF Malaria Elimination Initiative (MEI), discussed the gaps to implement effective, adaptive, and participatory community engagement strategies in the context of malaria elimination, and proposed solutions to these issues. While community engagement can be effective at improving uptake of health services and facilitating ownership of malaria interventions by the community, challenges to scaling up community engagement efforts include the lack of an agreed-upon definition of community engagement, the lack of human resource capacities related to community engagement, insufficient funding and interest, and poorly defined operational criteria for effective community engagement.

To increase documentation around effective community engagement and promote it in malaria elimination efforts, a team of researchers at MEI, led by Kelly Harvard, conducted a qualitative study assessing practical strategies of community engagement for consideration by malaria programs. Gosling described key findings from the study, and highlighted widespread misconceptions about community engagement, noting that “…very sadly, most of us in the malaria world thought that our job with community engagement was just to inform people.” He emphasized the principle that effective community engagement goes beyond what activities and strategies are implemented and considers how those activities are designed and implemented. Social and behavioral change communication (SBCC) and community health worker programs, for example, can contribute to community engagement, but do not inherently define it.

The study also resulted in a proposed common definition for community engagement in the context of malaria elimination: Community engagement is a participatory process that actively involves community stakeholders in the design, governance, delivery, monitoring and evaluation of malaria services.

Gosling ended with key action items and strategies for national malaria programs, funders, and other malaria programs to more fully engage communities in malaria elimination. National malaria programs can encourage district health units to map and engage with existing community platforms and to link these platforms with the health system. Funders can adopt this proposed definition for community engagement and support the budgetary frameworks that consider costs associated with effective community engagement. Malaria programs can be trained in participatory engagement approaches and establish links for annual planning with the communities partnering in malaria elimination efforts. Participatory engagement fosters innovation in a field that tends to rely on conventional interventions. “We know particularly in malaria, we’re very conservative, and we tend to do what we’ve done before,” Gosling said, “and bringing innovation into the malaria space is actually quite hard.”

Round Table participants, in addition to those mentioned above, included government officials from the Ministries of Health and national malaria programs of Angola, Namibia, Zambia, and Zimbabwe; representatives from the Clinton Health Access Initiative (CHAI), USAID President’s Malaria Initiative (PMI), Macha Research Trust, Harvard T.H. Chan School of Public Health, African Leaders Malaria Alliance (ALMA), End Malaria Council, SADC Malaria Elimination 8 Secretariat, PATH MACEPA and PATH Ghana, RBM Partnership to End Malaria, ISGlobal’s Malaria Elimination Initiative, Zambia Revenue Authority, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Drug Discovery and Development Centre (H3D); religious leaders from the Anglican Church, Caritas Angola, Council of Christian Churches in Angola (CICA), Islamic Supreme Court of Zambia, the Baha’i faith, the Episcopal Church, as well as program staff from the Isdell:Flowers Cross Border Malaria Initiative.