Category Archives: Community

Fighting Malaria with Community Case Management (CCM) Scale-Up in Kenya

Arianna Hutcheson has posted the following blog on our course website – Social and Behavioral Foundations of Primary Health Care

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Source: https://www.ifrc.org/Global/Publications/Health/Beyond_Prevention_HMM%20Malaria-EN.pdf

Access to health services is particularly difficult for the poor and those in more inaccessible areas of Kenya. This lack of endemic disease treatment for communities has proven to be quite deadly. With more than 11.3 million cases recorded annually, malaria is the leading killer of children under five years of age in Kenya. CCM, supported by organizations such as WHO and UNICEF, allows Kenya to effectively fight Malaria by using evidence-based life saving treatments that increase the availability and quality of proven interventions.

Using a CCM strategy has shown to decrease under-five malaria mortality by 60% overall under-five mortality by 40%. In Kenya particularly, the CCM pilot program has generated convincing results as seen in the graphic below.

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Access to Artemisinin-based Combination Therapy (ACT)  has increased and the education of communities provided by health workers has improved treatment seeking behavior. While the pilot CCM program is an important step to combating malaria, we are in the right time to take the success of this program and implement it country-wide.

Most importantly, CCM is part of the National Malaria Strategy, but it requires a more pronounced place in the plan to implement the successes of the pilot program in all 8 districts.

Action Needed: The Kenyan Ministry of Public Health and Sanitation (MoPHS) needs to commit and push ahead their own stated agenda for putting community health first by integrating malaria treatment into the already implemented diarrhea CCM program by the end of 2015.

Graphic: https://www.ifrc.org/Global/Publications/Health/Beyond_Prevention_HMM%20Malaria-EN.pdf

Expanding Health Ministry Capacity to Deliver Malaria and Other Health Commodities at the Community Level in Nigerian States

Bright Orji of Jhpiego‘s Nigeria office presents a poster at the American Society of Tropical Medicine and Hygiene 2014 Annual Meeting at noon on 5th November. The poster represents Jhpiego’s technical assistance provided to seven Nigerian States as part the World Bank Malaria Booster Program. The abstract follows:

CDI ModelThe highly participative process of community directed interventions (CDI) was first pioneered in 1996 by the African Program for Onchocerciasis Control for the delivery of ivermectin. CDI was further tested and found effective in delivering other health commodities.

In 2007 Jhpiego began a proof of concept project in Akwa Ibom State, Nigeria and learned that CDI could be a useful vehicle for increasing access to and coverage of malaria in pregnancy interventions. Building on this success, Jhpiego expanded this work to include integrated community case management of malaria, diarrhoea and pneumonia. through community led efforts.

Number trainedThe World Bank Malaria Booster Program, observing Jhpiego’s efforts in Akwa Ibom State, asked the Nigeria National Malaria Control Program to enlist Jhpiego’s help in building the capacity of seven State Ministries of Health (MOH) to organize CDI for what was termed the malaria plus package consisting of community case management and health promotion activities. The scale-up process started with workshops for state CDI implementation teams consisting of staff from malaria control and primary health care in the MOHs.

services providedThen these state teams developed their own intervention packages and organized workshops for local government teams, who in turn trained staff from their front line health facilities. These facility staff mobilized communities in their facility catchment areas (wards) to select volunteers for training on the CDI process and intervention package.

Although technical assistance was provided to each state, challenges arose including commodity supplies and coordination among different program units within the state MOHs. In conclusion, state teams can train local government teams, ultimately cascading CDI to the community in order to scale up maternal and child health interventions.

Prevention of Malaria in Pregnancy with Community Health Volunteers in Kenya: Jhpiego at ASTMH

CHV 1904-image-003Augustine M. Ngindu of Jhpiego’s USAID-MCHIP Project in Nairobi, Kenya will present a poster entitled, “Prevention of Malaria in Pregnancy: Community Health Volunteers (CHVs) promote community-based activities to increase uptake of Intermittent Preventive Treatment of malaria in pregnancy (IPTp) in Kenya,” at the ASTMH Annual Meeting at noon on Monday 3 October. Below is the abstract – stop by the session to learn more.

Malaria in pregnancy is associated with poor pregnancy outcomes including maternal anaemia, miscarriages and intrauterine growth retardation. In an effort to increase IPTp coverage, Kenya is implementing the community strategy by using community health volunteers (CHVs) to promote community-based activities to increase uptake of malaria in pregnancy interventions (MIP).

Bungoma Picture1The CHVs visit each household every month to register new pregnant women, collect data from existing pregnant women including last IPTp dose taken and gestation, sensitize them to continue ANC visits and refer late starters and defaulters of scheduled ANC visits.

In Bungoma sub-county with a catchment population of 169,000, 382 CHVs from 14 community units identified a total of 4,925 (95%) out of an expected 5,092 pregnant women and followed them up between February to April 2014.

In Kenya the recommended time for starting IPTp is from weeks of pregnancy or after quickening.

IPTp and CHV referralsResults showed that among the registered pregnant women 92% had taken at least IPTp1 and 61% IPTp2 doses respectively. IPTp doses taken by weeks of pregnancy showed that 1.3% had accessed IPTp by 16 weeks of pregnancy, 8.6% between 16-20 weeks, 4.7% between 21-25 weeks, 5.7% between 26-30 weeks, 6.5% between 31-35 weeks and 3.7 % between 36-40 weeks.

IPTp doses Picture1However, 1.5% had not started IPTp at 40 weeks of pregnancy. The data further showed that among those who started IPTp early 1% completed 7 IPTp doses at 40 weeks of pregnancy.

CHVs can be used to effectively promote community-based activities including collection of data on the number of IPTp doses taken during pregnancy, which is a good indicator of the proportion of pregnant women protected against the adverse effects of malaria during pregnancy. This practice if scaled up can serve as an alternative method of monitoring coverage rates of interventions without waiting for the 3-5 year community survey data

Ghana at ASTMH: Mapping out of antimalarial drugs on stock at the market in a rural districts of Ghana

The first Poster Session of theDodowa American Society of Tropical Medicine and Hygiene (Monday noon) will feature a study on availability of malaria medicines in rural Ghana. “Mapping out of antimalarial drugs on stock at the market in a rural districts of Ghana” was developed by Alexander A. Nartey, Evelyn K. Ansah, Patricia Akweongo, Gloria A. Nartey, Mary A. Pomaa, Doris  Sarpong, Clement Narh, and Margaret Gyapong of the Dodowa Health Research Centre.

AA Picture1Antimalarial drugs are a very important component of any policy for effective reduction of morbidity and mortality related to the malaria disease. The availability of efficacious and high quality antimalarials and their correct use can mitigate the risk of morbidity and mortality among the people of sub-Saharan Africa who have the highest risk of contracting and dying
from malaria.

Chemical (medicine) shops are major source of care for most developing countries where anti-malarial drugs can be purchase at the counter. The paper seeks to identify the different kinds of anti-malarial drugs on the market for malaria treatment in a rural district in Ghana.

Chart Picture1A structured questionnaire was used during two seasons (peak and low malaria transmission seasons) to collect information on anti-malarial drugs from all 58 chemical shops within the Dangme West district now (Shai Osudoku and Ningo Prampram districts). Pictures of the anti-malarial drugs were taken,

The active ingredients, and also the source of the drugs documented. GIS locations of the shops were also recorded to ascertain the proximity of the shops to households in the communities. Majority (72.0%) of the chemical and pharmacy shop owners are males. Only 7.0% of the shops are pharmacy while the remainder is licensed chemical shops.

GHSThe total numbers of antimalarial drugs counted were forty nine (49). Among the stock, 4.2% were quinine, 31.9% of them were monotherapies such as artemether, Amodiaquine, Artesunate etc. Altogether, 59.4% of the artemisinin combination therapies (ACTs) were artemether + Lumefantrine, 25.0% were Artesunate + Amodiaquine.

Other antimalarials observed were 9.4% Sulfadoxine + Pyrimethamine and 3.1% of of Artesunate + Sulfamethoxypyrazine + Pyrimethamine. About 47% of the anti-malarial drugs were pediatric formulations.

Map Picture1GIS mapping shows that majority of the households are within a periphery of 5km to a chemical shop.

The national antimalarial drug policy recommends the use of ACTs for malaria treatment however; all sorts of anti-malarial drugs which are not ACTs are in stock at the chemical shops in Ghana. Chemical shops are closer to households and play a very important role in the treatment of malaria hence there is the need to train chemical sellers to stock and administer the recommended antimalarials.

The reception of village malaria workers in rural Cambodia: knowledge, perceptions, and preferences in user communities

The recently concluded Global Health Systems Research Symposium in Cape Town featured a number of abstracts that touched directly or indirectly on malaria. Malaria services and movement toward malaria elimination cannot be achieved in a country without a strong health system that involves both communities, program staff and policy makers.

globalsymposium_logosBelow is an abstract by Marco Liverani, Ra Sok, Daro Kim, Panarith Nou, Sokhan Nguon, Chea Nguon, Shunmay Yeung of the London School of Hygiene and Tropical Medicine, UK, Partners for Development, Cambodia and Ministry of Health, Cambodia on malaria village health workers in Cambodia.

“Despite sustained efforts to strengthen the health system and significant progress, Cambodia still suffers from critical shortages of health professionals and inequities in the distribution of health services. This problem is particularly acute in remote areas, where the incidence of infectious diseases such as malaria and typhoid fever is higher, where access to health facilities may be limited by environmental barriers, and where poor communities bear the greatest economic burden of illness.

Village Malaria Worker courtesy of WHO: http://who.int/malaria/areas/greater_mekong/cambodia-frontline-heroes/en/

Village Malaria Worker courtesy of WHO: http://who.int/malaria/areas/greater_mekong/cambodia-frontline-heroes/en/

“Over the past decade, the deployment of lay members of the community to provide basic medical services amongst the most vulnerable populations has been one of the key interventions to address this problem.

“We conducted a qualitative study to examine the reception and impact of the Village Malaria Workers (VMW) programme in Cambodia, a community-based intervention to support the management of malaria cases and childhood illnesses.

“Methods included observations and in-depth interviews (n=80) in user communities. A thematic question guide with open-ended questions was used for the interviews. Thematic content analysis was then conducted to explore factors that may promote or discourage service utilisation.

“Many respondents thought that VMWs can deliver appropriate medical care and services, but some expressed a preference for private providers as these were seen to offer more comprehensive and qualified health care. Many respondents had inadequate awareness of VMWs and the range of services they provide.”

“Findings from our study point to the need for innovative communication strategies to increase the utilisation of VMWs. We argue that investment in symbols and visual communication tools are required to promote the visibility, status, and identity of health volunteers in user communities, also given current policy trends – in and outside Cambodia – towards an increasing use of community workers to perform roles and tasks that are conventionally associated with health professionals.

Is community case management sustainable in Mozambique? A qualitative policy analysis

The recently concluded Global Health Systems Research Symposium in Cape Town featured a number of abstracts that touched directly or indirectly on malaria. Malaria services and movement toward malaria elimination cannot be achieved in a country without a strong health system that involves both communities, program staff and policy makers.

globalsymposium_logosBelow is an abstract by Baltazar Chilundo, Julie Cliff, Alda Mariano, Daniela Rodrigues, and Asha  George of the University Eduardo Mondlane, Mozambique and the Johns Hopkins School of Public Health on the sustainability of community case management, building on longstanding community health worker programs.  They stress the importance of community commitment, an often missing factor when CHW and CCM programs are organized by national agencies.

“In Mozambique, community case management (CCM) of diarrhoea, malaria and pneumonia is embedded in the national community health worker (CHW) programme. Since 1978 this programme functioned fitfully and was relaunched in 2010, with a target to train and retrain over 6000 CHWs.

MOZ_mean“Considering the checkered history of the CHW program, sustainability lies at the heart of concerns related to the design and implementation of CCM in CHW programs at scale in Mozambique and in people centred health systems more broadly.

“Using qualitative retrospective case study methodology, we reviewed 54 national documents and interviewed 21 key national informants for a policy analysis of CCM in Mozambique. The data were analysed thematically according to a sustainability framework and validated though a national debriefing workshop.

“The sustainability of CCM was facilitated by embedding it in the national CHW programme, which was relaunched after wide consultation within government and with supportive donors and non-governmental organizations (NGOs).

“Although communities were not widely consulted, they were eager for CHWs to provide curative services. The new CHW program aimed to improve CHW retention, by paying them a salary and giving priority to females. However, salary costs come from partners and in practice most CHWs are male.

“The poor capacity of the health system to adequately supervise CHWs and guarantee drug supplies for CCM, the dependence on external partners for funding, and on NGOs for implementation and the lack of mobilization of communities and top policy makers remain critical concerns.

“Embedding CCM in the national CHW programme favoured sustainability, however this made CCM susceptible to the same factors that undermine sustainability of the CHW programme. Moving forward, these policy concerns need to be addressed to ensure a national CHW program, responsive to community needs, supportive of CHW themselves and owned by national governments.”

 

Registered drug shops are preferred for treating acute febrile illness in rural Uganda

The recently concluded Global Health Systems Research Symposium in Cape Town featured a number of abstracts that touched directly or indirectly on malaria. Malaria services and movement toward malaria elimination cannot be achieved in a country without a strong health system that involves both communities, program staff and policy makers.

globalsymposium_logosBelow is an abstract by Freddy Kitutu, Chrispus Mayora, Phyllis Awor, Forsberg  Birger, Stefan  Peterson, and Henry Wamani of Makerere University and the Karolinska Institute on use of medicine shops in Uganda.

“Under-five child mortality in Uganda is still high and majority is caused by easily treatable pneumonia, malaria and diarrhoeal diseases among the poorest people. One of the reasons for these deaths is the lack of timely access to proven life saving medicines. This hinders progress towards attainment of MDG 4 target by 2015.

“To increase access to quality medicines and diagnostics for child febrile illnesses, Makerere University School of Public Health (MakSPH) in collaboration with WHO Alliance for Health Policy and Systems Research, is doing a project to assess the potential to deliver quality integrated care for malaria, pneumonia and diarrhoea using integrated community case management (iCCM) strategies and tools. Hence, an assessment was conducted to determine baseline care seeking preferences.

“A baseline household survey interviewed caregivers of children under-five years. The study protocol and data collection tools had been reviewed and approved by Research and Ethics Committees at WHO, MakSPH and Uganda National Council of Science and Technology.

“A total of 2606 households were surveyed. The main childhood diseases reported included fever (70%), cough (77%), and diarrhoea (40%) convulsions (16%) Most households use private drug shops to purchase medicines to manage these illnesses. Use of drug shops was attributed to long distances to public health facilities, availability and reliability of drug stocks at drug shops, perceived high quality of services, and options for credit.

“Interventions that target public health facilities are likely to miss many healthcare seekers especially the poor in rural distant areas. Conclusion: Drug shops are the convenient and preferred outlets for rural poor communities, and therefore need to be included in interventions such as iCCM strategy.

“Significance for the selected field-building dimension: This abstract presents findings from the baseline assessment prior to introducing a health system intervention in drug shops to improve access to and quality of care for under-five children.”

Communication Challenges: Malaria or Ebola

The purpose of health education of behavior change communication (BCC) is to share ideas such that all sides of the communication process learn to act in ways that better control and prevent disease and promote health.  Both community members (clients) and health workers (providers) need to change behavior is their interaction to become a health promoting dialogue.

This dialogue becomes easier when all parties share some common perceptions about the issue at hand. Both health workers and community members can usually agree that malaria often presents with high body temperature. Also both usually agree that malaria can be disruptive of daily life and even be deadly.

But there are differences. While both may agree that there are different types of malaria, the health worker may mention different species of Plasmodium such as falciparum, ovale, vivax, malariae and now even knowlesi. The community member may think of yellow malaria, heavy malaria, aching malaria, and ordinary malaria. These differences may put acceptance of interventions to control malaria into jeopardy. Fortunately, current downward trends in malaria incidence imply that our communicants have more in common than not.

Cases 20140924Along comes Ebola Viral Disease in West Africa, which has killed around 3000 people in Guinea, Liberia, Sierra Leone and Nigeria at this writing.  The disease has never been seen on that side of the continent before. It is spreading more rapidly than it even did in its previous East and Central African outbreaks.  How does one communicate with people – both community members and health workers – about a disease they have never seen before?

The following encounter reported by BBC shows the initial confusion.

Not infrequently in the last few weeks I’ve encountered people complaining of a headache or a night of intense sweating. They slide off to the hospital and reappear a day or two later with a bag full of drugs, and they laugh it off. “Oh yeah, there are so many mosquitoes at this time of year,” they say. Better it be ‘normal’ malaria than death (Ebola).

The confusion results in harmful changes in treatment seeking behavior according to the The Pacific Northwest Conference of The United Methodist Church.

Misinformation and denial are keeping sick people from getting help. Some people are hiding from government officials and medical teams because they fear that if they go into quarantine, they will never see their loved ones again. Since the early symptoms of malaria and Ebola are similar, many malaria patients are not getting treatment. This crisis jeopardizes the progress toward improving access to health care generally.

In his blog, Larry Hollen summarizes the dilemma as follows: Both diseases disproportionately affect the poor and ill-informed Because Ebola and malaria have common early symptoms, such as fever, headache and vomiting, there may be confusion about the cause of illness among both those who are ill and health care providers.

Efforts to communicate the nature and dangers of Ebola have proceeded anyway. Posters, billboards, radio spots and even local volunteers with bullhorns, armed with information from the ministries of health or NGOs remind people that Ebola can kill and that people must report to a health facility for testing and care.

This top-down approach to communication often meets skepticism and suspicion. The messages also do not match reality when people find health centers closed due to loss of staff or health workers reluctant to see febrile patients fearing that they may have Ebola, not malaria. A health education dialogue cannot take place under such circumstances.

In fact suspicion is the order of the day. Sierra Leone and Liberia have emerged not long ago from brutal civil wars that not only destroyed must health and other infrastructure but killed much of their populations and alienated those who survived. Reinforcing this suspicion and distrust are militaristic approaches in both countries to contain the poor populations most affected.

False rumors are spreading that the international donors who are slowly rallying resources to fight the disease are actually the ones who may have created and started the spread of Ebola. It is unfortunately not surprising under such circumstances that a health education team going to a remote village in Guinea were killed.

Some positive approaches to Ebola communication have been documented including the use of trusted community health workers making door-to-door visits in Sierra Leone. More effort is needed to plan a more inclusive dialogue among all parties in order to halt the Ebola epidemic. Dialogue can start from the known – like the similarities with malaria – and move into the unknown. Drugs and vaccines will not be enough, if trust and good communication are lacking.

Journal of Indigenous and Community Communication (JICC)

Colleagues at the University of Ibadan have started on an important publishing endeavor as described below. Indigenous communication is an often neglected aspect of behavior change communication, and we hope this new Journal will bring more attention on how we can communicate about important health issues like malaria in ways that make sense to the community. Of course we also need to be willing to learn from the community first about their perceptions in order to have effective two-way communication:

Call for Papers for the Maiden Edition

JICCThe Editorial Board of the Journal of Indigenous and Community Communication (JICC) hereby invites original research articles, (empirical and discursive/expository), for the maiden edition of the journal that will be published in December 2014. JICC aims at offering space for scholars, researchers and development practitioners to contribute both qualitative and quantitative research findings in form of case studies, community-based situation analysis, reports of community-based interventions, evidence-based policy suggestions and intervention measures, and policy briefs. This volume will explore the theme of Community Communication and Poverty Reduction in Africa, with particular reference to the voices from community’s grassroots.

From recent researches,[1] the number of people living in absolute poverty in Africa is still high compared to most other low-income regions. Reasons given for the soaring numbers are diverse, ranging from leadership, irrelevant policies, failing institutions, human geography, among others. There are however many success stories from different African countries, stories that hardly get to find audience at the national and international levels, stories of people who through their daily struggle contribute to their betterment of their livelihoods.

This maiden edition is dedicated to how the community grassroots’ communication mechanisms contribute towards alleviating absolute poverty for those involved. Contributions to this edition should therefore centre on the efforts of knowledge and idea transfer at the very community’s basic level. Key questions around this focus include: In what ways do individuals get to exchange ideas about their own, and community’s development? Who takes initiative in the transfer of these ideas, and what informs this initiative? How (in)effective are these modes of communication? How can these grassroots, community-based communication initiatives become more widely accepted and engaged in dealing with poverty issues in African communities? What are the implications of these modes of indigenous/community-based communications with regards to reducing poverty in Africa?

Articles that explore these and other related questions, and especially field researches that are innovative and original are welcome.

Abstract submission

The first stage is to submit an abstract of a maximum of 300 words. In the abstract, indicate the gap that exists in literature and/or the key research question. It is important to link the key question to poverty and communication. Include the area (geographical) specificity of research in the case of empirical data and methodology, and how the findings will be useful in addressing/answering your research question. Include your name, institutional affiliation and email address. Once the editors have reviewed the abstracts, authors whose abstracts are accepted will be contacted to submit full papers. The deadline for abstract submission is August 10 2014. The abstracts should be submitted to: ayo.ojebode@mail.ui.edu.ng and mbusupa@yahoo.com

Article submission

Full articles should be written using the APA 6th style referencing. The words should be limited to 7,000 including footnotes and list of references (avoid providing bibliography). Briefings and policy briefs that provide review of specific country’s topical issues should be limited to a maximum of 3,000 words. Book reviews that are relevant to the theme of the edition should not exceed 1,000 words. Full articles for this volume are due November 15 2014.

JICC does not accept articles that are under consideration by other publishers. JICC does not compromise on matters of ethics and integrity. All academic articles will be peer-reviewed blind by three reviewers. An article is not recommended for revision unless it has at least two positive reviews. Two reviewers will review briefs and reports by organisations working in communities. JICC also strives to ensure that reviewers’ reports are turned in within six weeks. JICC conducts plagiarism checks on each article submitted to it. Any article that fails the test will be rejected and the author(s) will be barred from publishing in JICC in future.

JICC will be published availed online and in print.

Funding and Outlet

The Nigerian Community Radio Coalition supports JICC. However, we welcome support from other institutions and individuals in Africa and beyond.

JICC Editorial Board:

  1. Dr. Ayobami Ojebode – University of Ibadan, Nigeria
  2. Dr. Susan M. Kilonzo – Maseno University, Kenya
  3. Dr. Tunde Adegbola – African Languages Technology Initiative, ALT-I, Nigeria
  4. Prof. Holger Briel – Xi’an Jiaotong Liverpool University, Suzhou, China
  5. Prof. Kitche Magak – Maseno University, Kenya
  6. Prof. Christopher J. Odhiambo – Moi University, Kenya
  7. Dr. Birgitte Jallov – Empowerhouse, Denmark
  8. Ms. Jackline A. Owacgiu – Uganda/London School of Economics

[1]See for example Collier, P. Poverty reduction in Africa. Accessible at http://users.ox.ac.uk/~econpco/research/pdfs/PovertyReductionInAfrica.pdf. Collier’s book-The bottom billion: Why the poorest countries are failing and what can be done about it. New York, Oxford: Oxford University Press, explores this further.

Tanzania Community Health Workers Blog on Malaria and Other Concerns

The Connect Project of Ifakara Health Institute of Tanzania and Columbia Mailman School of Public Health with the support of the Doris Duke Charitable Foundation has trained community health workers known as Community Health Agents (CHAs), or the ancronym WAJA in Swhili, in three districts in Tanzania. The project has encouraged the CHAs to start blogging their experiences and challenges in promoting community health. Below are two examples of their work as it involved malaria.  More postings can be viewed on WordPress.

Net VoucherBoniface Madina Mwandishi, that CHA from Katindiuka Village, is particularly concerned about preventing malaria in pregnant women. When He talked to women in his service area he learned that the net voucher system that allows women to get insecticide treated nets at half the going price of TSH 2,500 (~$1.50) had problems.

First the vouchers were either late or not available in the nearby health facilities.  Many cannot afford to pay the full price. Thus most women are not using nets to protect themselves and their unborn children from malaria.

A village elder complained to Boniface that his wife was not able to obtain a net even until a month after their child was born. The elder stressed that had the vouchers and nets been available more women and children would have been protected from malaria. Boniface will follow up to report on the lapses in the voucher system.

motherCastor Mwinamile, the CHA from Mchombe Village, reports on problems with Malaria Rapid Diagnostic Tests (RDTs). He had called mothers together for health education, but they also used the opportunity to complain about the current stock-out of malaria RDTs in the village.

Mothers noted that without RDTs the actual disease of their sick child could not be determined easily. Maybe the child with fever had a urinary tract infection or maybe it was malaria. The CHA promised the mothers to inform the project quickly about the stock-out.

While CHAs are given basic phones to communicate with supervisors and among themselves, some do have smart phones and are able to post on the blog and share with their fellow CHAs who may not have a phone.

The feedback to the program and shared learning among the CHAs, enabled by the blog, demonstrate a unique learning and problem solving experience in community health. These two postings also show that the CHAs have made their communities aware of the benefits of malaria services, hence their demand for better access.

There are other postings about malaria on the Sauti ya Waja, so if your Swahili is adequate, we encourage you to also learn from the Community Health Agents of Tanzania.