World Malaria Day 2011 celebrates “Achieving Progress and Impact.” Major increases in intervention coverageÂ and reductions in morbidity and mortality have been documented. Yet we are still a long way to go in achieving targets, especially for protecting pregnant women and treating vulnerable children.
In 2011 key interventions like prompt and appropriate diagnosis and treatment still do not reach all endemic communities. In several countries the health services still do not trust community members, and this is impeding progress, let alone impact.
A common belief among health workers in some countries, from upper level Ministry officials to front line primary care staff, is that the community cannot be expected to handle malaria diagnosis with RDTs and treatment with ACTs. In these locations Roll Back Malaria has yet to roll back the medical model of malaria elimination and trust the affected populations to play a major role in providing their own care.
Years of experience with onchocerciasis control tells a story of initial skepticism that communities could handle ivermectin, and yet 16 years after the African Program for Onchocerciasis Control was launched, over 100,000 communities regularly control and direct their own ivermectin distribution.
Studies by the Tropical Disease Research Program of UNCP/World Bank/UNICEF/WHO have shown that these same communities can effectively develiver malaria control services (ITNs and ACTs) along with their ivermectin duties.Â
In Rwanda village health workers are the major providers of malaria diagnosis and treatment using RDTs and ACTs.Â It can be done if there is willingness to form working partnerships with communities.
The problem goes beyond malaria case management.Â Recently the Global Fund pointed out to a grant recipient that coverage targets could not be met without an active role of communities in malaria case management. Communities needed to do more than provide behavior change communication telling residents to trek dozens of kilometers to the nearest health facility for care.Â
In fact the Global Fund learned that this country had no policy for community case management of any illness. The nature of such medicalized and inaccessible health care is to condemn thousands of malaria sufferers to death.
Community members can make a difference, as Jhpiego has found in Akwa Ibom State, Nigeria.Â Through training and supervision, communities can effectively take charge of meeting their health needs.
Progress will come only when health officials recognize that they cannot achieve impact alone. They must actively involve communities in decision making, planning, service delivery and evaluation of malaria is ever to be eliminated.