District health officials in Ghana know that the life saving benefits of malaria interventions cannot be sustained without the community. GNA reports that, “Sunyani Municipal Health Directorate has concluded its 2008 review meeting with a call on mothers to continue to use insecticide treated mosquito bed nets for their children.”
Reported malaria deaths in the district have droped by around 4% in both 2007 and 2008. “The statement attributed the achievement to the intensification of health education on malaria (emphasis added), distribution of insecticide treated bed nets to children and improvement in case management of the disease.’
Health education, if properly done, is not just about posters, radio spots and messages, though these have their place. The right kind of health education involves people in understanding health issues in the context of their own culture and enables them to make decisions and take actions that will keep them healthy.Â Health education is a discovery process – it is voluntary. Simplifying things to behavior change leaves the door open to coercive methods, benign (and often ineffective) information provision or active engagement – we need to be careful not just with terminology, but also with intentions.
The best of health education is an enabling process. The community directed interventions (CDI) approach, spearheaded by the African Program for Onchocerciasis Control and lately applied successfully to malaria interventions, engages the community in providing their own malaria control services with supportive supervision from the health system.Â Other models exist such as community coalitions used by the COMPASS Project in Nigeria. Readers are encouraged to share their own experiences.
The key point is that unless the community is actually engaged, people will not obtain the correct malaria medicines and take the full course. They may get free nets, but may not use them regularly and correctly. It is ultimately the community that decides if malaria interventions will be effective. CDI involves communities all along the road, and even beyond the end of the road, in managing their own health programs. We need more community efforts to ensure that malaria elimination is in the hands of the community people who are affected and who ultimately make the difference.