By Kemo Cham (Chairman of FOCUS 1000 Kombra Media Network)
In the last 15 years, up to 2017, the Global Fund has invested US $10.5 billion in the fight against Malaria. Much of that money went to Africa and Asia - the two World Health Organisation (WHO) regions with the highest prevalence rates.
In spite of this huge investment, Malaria remains a major public health concern in many of the affected countries, including Sierra Leone where campaigners are calling for an intensification of the fight against the pandemic.
The Catholic Relief Services (CRS) alongside the National Malaria Control Program (NMCP) of the Ministry of Health and other partners are championing the crusade with an experiment of a community-led initiative that seeks to leverage influential voices with the aim of changing behavior, which many believe is the major hindrance to progress against the disease.
About a hundred people, drawn from traditional, religious, youths and women’s groups and representing the 11 chiefdoms in Port Loko, last week gathered in the northern Sierra Leonean district to deliberate on the issue.
Ebrima Jarjou, Global Fund’s Project Director at CRS, says until now anti-malarial response has been mostly one way communication, which they believe has failed to deliver expected impact. He explains that this approach is designed to unearth the unknown through the greater involvement of the grassroots.
Malaria is a deadly disease caused by the Plasmodium parasite, which is transmitted via the female anopheles mosquito. Transmission depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity.
In many places, transmission is seasonal, with the peak during the rainy season, as is the situation currently in Sierra Leone.
According to Malaria Indicator Survey (MIS) 2016, the northern region of the country has the highest prevalence rate of the disease by microscopy, with 52 percent. The southeast has a prevalence rate of 40 percent, while the western area is 6 percent.
The National Malaria Control Strategy emphasizes on prevention and control through vector control, case management, and malaria in pregnancy. CRS, which seeks to ensure services are utilized, complements the efforts of NMCP and other stakeholders.
As one of the Principal Recipient of the Global Fund support, CRS’s normal activities entail the use of community and school health clubs who conduct outreach and community meetings in strategic locations, talking about malaria prevention and control.
Campaigners say evidence abound that low service uptake is responsible for the persistently high prevalence rate of malaria.
In Port Loko, for instance, only 34 percent of the people sleep under bed nets, even with a relatively high rate of ownership - 62 percent.
“So, it is the utilization of the services that’s weak. This is why we are taking this process of engaging community leaders who are expected to go to their communities to do in-depth analysis of the reasons why people are not practicing the correct behavior to protect themselves against malaria,” says Jarjou.
In about nine hours of deliberations, participants were treated to speeches and presentations on the malaria burden, its economic and social implications. Sister Kumba Wani Lahai of the NMCP made a contrasting presentation on malaria trends as shown in the 2016 and 2013 MIS editions.
Participants were then split into three groups, representing the youths, traditional and religious leaders and women’s groups.
The outcomes of the discussions constituted the basis for the action plan for stakeholders in each chiefdom. The Paramount chiefs, the highest authorities in the chiefdoms, made public declaration committing themselves to pursuing these action plans.
This is all part of a pilot project that includes the southern Bo and Pujehun districts, which officials say could be rolled out to the rest of the country.
The goal, explains Joseph Kargbo, District Supervisor of the Community Action For the Welfare of Children (CAWeC), the local implementing partner of CRS, is to get everyone sleep inside a bed net every night, seek treatment within 24 hours following onset of fever, and for all pregnant women to take at least 3 doses of malaria prevention medicine available at all government health facilities throughout the pregnancy.
Like many other activists, Kargbo believes that the issue is mostly behavioral, citing all the actions taken by government and partners, including free mass distribution of insecticide treated bed nets.
In 2017, over 4.2 million bed nets were distributed across the country.
The government says it has always made malaria treatment free of cost for all categories of people to ensure maximum access.
In spite of all this, people still make flimsy excuses for not sleeping inside their bed nets, like the feeling of discomfort, laments Kargbo. Others, he says, simply refuse to visit the hospital when they fall sick and some give the excuse that they do not have money to pay for treatment.
But there are also concerns about the distance between some communities and health facilities, which campaigners admit discourage hospital visits.
Nonetheless, Mohamed Bah, M&E Coordinator of the Global Fund Project at CRS, agrees that much of the problem is behavioral. He says the services are there but people aren’t just making use of them.
“We want to change that. It has worked during Ebola. We fought it and when we brought in the community people it ended Ebola,” he said.
Sierra Leone has some of the world’s highest rates of maternal and child mortalities. Malaria, which accounts for the highest outpatient cases, is a major contributor to this. Over two million cases are recorded annually, half of which are children, according to the MIS.
In pregnancy, malaria is associated with low birth weight, premature and still birth.
The global antimalarial crusade targets reducing cases by 40 percent by 2020, under the 2015 [MDGs] baseline; and the new UN SDGs seek to reduce it by 90 percent by 2030.
During the last World Malaria Day commemoration, WHO warned of a stall in progress against the disease and said the current pace was insufficient to achieve the 2020 milestones.
“Countries with ongoing transmission are increasingly falling into one of two categories: those moving towards elimination and those with a high burden of the disease that have reported significant increases in malaria cases,” it said, urging member countries and partners to step up efforts.
Experts say the best way to fight malaria is to sleep inside bed nets.
Yet the 2016 MIS reveals worrying accounts of misuse of bed nets. Some people convert them to fishing nets, while youths use them as goal posts in soccer games. Others used them to control indoor pests, wherein the nets are placed under mattresses to kill bedbugs.
Community leaders are expected to discourage all such misuses and ensure strict adherence to environmental sanitation to deny mosquitoes breeding grounds. They will also seek to address the drug peddling phenomenon.
Because of a huge gap in drug regulation, there has been a proliferation of quack doctors who provide a ready market for counterfeit and expired drugs. The worst effect of this is that they contribute to low hospital visits because many Sierra Leoneans prefer their cheap drugs.
Jarjou says this community engagement will provide the platform to strengthen collaboration between health facilities and communities against malaria by ensuring supplies are consistently available in health facilities. While religious leaders are expected to use their pulpits to appeal to the conscience of their congregations against service misuses, the chiefs will use their political authorities to deal with noncompliant subjects.
After every quarter, each chiefdom is assessed according to their commitments and where there are shortfalls, bylaws are instituted or reviewed.
Officials say this approach is based on the lessons learnt from the experience dealing with the 2014 West African Ebola epidemic which ravaged Sierra Leone and its neighbors - Guinea and Liberia, claiming over 11, 000 lives, among nearly 30, 000 cases.
“We have learnt our lesson,” says Dr. Mahmoud Idriss Kamara, District Medical Officer, Port Loko.
“You can’t fight a disease without the people,” he said at the Port
Loko town hall meeting, warning that “victory” could only be possible over Malaria if the same time and efforts expended on Ebola is accorded to the parasitic disease.
Source: 2018 Politico Online