By this time next week Jhpiego with a grant from the ExxonMobil Foundation will have trained approximately 600 volunteer community distributors for controlling malaria in pregnancy (MIP) in 14 health facility catchment areas of four local government areas in the southern part of Akwa Ibom State, Nigeria. Very few efforts to involve the community directly in MIP control activities have been reported, but what distinguishes the Jhpiego effort is conformity with the standards set by the African Program for Onchocerciasis Control’s community directed treatment with ivermectin strategy. The key is linking the effort with the local health service to enhance supervision, monitoring and commodity flow.
a baseline survey in the study area showed that only around 5% of pregnant women had received two doses of SP for IPTp from a health service during their last pregnancy and less than 2% has slept under a LLIN anytime during their pregnancy. Community involvement was a clear need.
Effort started by building a team of core trainers among state health ministry and NGO partners. This team in turn trained local government health health management staff, who in turn trained local health facility staff in the area of malaria control and community directed interventions. During the past two weeks these local health staff have undertaken community mobilization including community meetings to answer questions about community roles in selecting and supervising their own volunteers.
There can be three to eight communities in a health facility catchment area. Once communities have agreed to take part, they look to the next smaller unit, the kindred or clan, and this extended family unit is the one that actually selects volunteers so that these can be immediately accountable to their own family members.
Eleven catchment areas have completed training and are embarking on community resource mapping and census to help estimate the need for commodities including ACTs for children under five, LLINs for pregnant women and children under five and sulfadoxine-pyrimethamine (SP) to use in IPTp for pregnant women. The state ministry is expecting malaria commodities soon from the World Bank Booster program, and these will be channeled through the local governments to the front line health facilities and to the community volunteers. A monitoring and evaluation system is being put in place so that the volunteers report back to the facilities who in return report to the local government and state.
Finally the volunteers will also refer pregnant women to the nearest facility to get all the required services for antenatal care. Jhpiego is working with the facility staff to develop quality assurance standards because poor quality was reason given by community members for not utilizing ANC in the past. Hopefully this community-clinic partnership will go a long way to reducing MIP in Akwa Ibom State.