Do we take the community seriously – not just as recipients of information? Susanna Hausmann-Muela of the Swiuss Tropical institute raised this important question at the start of her talk to participants at the Asia Pacific Malaria Elimination Networkâ€™s Community Engagement for Malaria Elimination Workshop on Tuesday. She stressed the importance of dialogue and mutual learning so that we may learn from the community how they perceive malaria and understand their response to it.Â Their response likely reflects the many troubles in peopleâ€™s lives – trying to access food, jobs, education – and malaria may be the straw that breaks the camelâ€™s back.
We need to learn from people what kind of bednets are â€˜rightâ€™ for them and not assume that synthetic fiber long lasting insecticide treated net that has survived scientific efficacy trials is the one size that fits all.Â At the same time we should not abandon scientific rigor, because randomized control trials of community participation have shown the effectiveness of community participation in reducing neonatal mortality and dengue serological indices in communities. We need similar evidence for malaria interventions. Such interventions though, need to be designed with and by the community bearing in mind APMENâ€™s community participation framework.
Jeffery Smith of the World-Wide Antimalarial Resistance Network based in the Mekong Region encouraged workshop attendees to learn from the long history of participation by communities and people living with AIDS who took charge of their situation when science alone was not enough to solve the problems of the epidemic.
He encouraged the group to think more broadly about the term community, especially in todayâ€™s climate of high mobility, migration and air travel.Â Communities everywhere, not just those that physically border endemic countries, need to be vigilant and incorporate malaria surveillance activities into other primary health care programs.
Choosing an appropriate mix of community intervention tools was the theme of the talk by Bill Brieger of the Johns Hopkins University.Â He provided examples of how local settlements in partnership with front-line health facilities use a community directed interventions (CDI) approach to increase access and coverage of malaria interventions and other basic health services. Community systems and health systems must collaborate.
A major challenge of CDI is not the willingness and ability for communities to plan and deliver nets, IPTp, RDTs and ACTs at the local level, but in helping health workers and program managers overcome their biases against lay people and ensure that they maintain the supply chain so the community has the commodities needed to provide life saving services at the grassroots.