Africa: Why Community Engagement is Critical in Fight Against Malaria

A health worker, testing children for malaria along Namibia's border with Angola, wears a t-shirt showing the collaborative effort of the Elimination 8 campaign (file photo).
5 March 2021

Johannesburg — Partners in malaria elimination have come together on community engagement in malaria control and elimination, and shared tools and experiences on fighting the parasitic disease. The gathering on February 19 included researchers, community leaders, academics and international partners.

Opening remarks were by Kelly Harvard, a researcher at Malaria Elimination Initiative, the University of California, who presented results from a background paper on community engagement, on behalf of her fellow researchers.

According to Harvard, community engagement should be a central feature of malaria programming. However, community engagement is not consistently defined, operationalised, or evaluated and this has led to a number of different activities, strategies, and programs all commonly referred to as community engagement even though the goals and outcomes vary and this is true across many different health programs.

"In the context of malaria, other important gaps have also been identified such as lack of adequate human resources and capacities related to community engagement, insufficient funding, and interest in issues relating to broader health systems and operational criteria for effective community engagement are also poorly defined," Harvard said.

Among the speakers was Joao Baptista Nelo with Isdell: Flowers Cross Border Malaria Initiative and the Anglican Diocese of Angola and a member of Civil Society for Malaria Elimination (CS4ME). Nelo shared a success story of effective community engagement in Cuando Cubango, a province in Angola. The community engagement project that he is part of is called Community Malaria Elimination Committees (COCEMAs).

"The Eastern cross-border malaria initiative is committed to malaria elimination through community mobilisation along the shared borders with Angola, Namibia, Zambia, and Zimbabwe. We believe that malaria can only be eliminated if those living with the disease have the knowledge and skills and have resources to prevent it to treat the disease and to advocate for its elimination," said Nelo.

"Malaria is a primary cause of death in Angola and in Cuando Cubango where we work from it has 38% prevalence in children under the age of 5, that is according to the DHS 2015/16. There are very few government services in this area and before Covid-19 people often cross to Namibia to look for better health care. The community in this area are isolated, so we are talking about 12 hours of driving from this area to the provincial capital, Menongue. Historically there has been a few malaria activities happening in the area," he said.

"So the community decided to organise themselves in groups in order to keep the key malaria activity running and that's where the COCEMA comes in. They are community-owned committees and through them, all the analytical diocese and the Isdell Flowers Malaria activities are conducted under their leadership. Through COCEMA leadership is transferred to the hand of the community in order for them to keep running community activity even without external intervention."

What is a COCEMA?

It is a community-owned group whose members are chosen from the community and the selection of its members is not related to any formal education but it aims for a well-balanced group of 8-12 members and this includes village headmen or chiefs, religious leaders. The COCEMA capacity building should happen at the invitation of the community and the COCEMA should not be affiliated with any political party to avoid conflict plus the COCEMA determines their own procedures and operation so they decide which day of the month, where to meet, what to discuss and how to address some issues within their communities.

What do COCEMAs do?

  • They engage in malaria donation activities
  • They identify and address barriers to effective implementation
  • Select, support, and manage community malaria volunteers
  • Advocate for services desired by the community
  • Serve as a bridge between community and government
  • Act as a community platform to address other issues affecting the community as they rise

"The Anglican Diocese of Angola and the Isdell Flowers interact with the COCEMAs by providing training sessions for the volunteers that are selected by the COCEMA, support during meetings to assure that the minutes that are taken are shared with every partner that is interested and the guidance structure for new COCEMAs," said Nelo.

"We also collaborate in a way that trained volunteers to have oversight from our field officers on the ground and we also help to link the COCEMA to the government sector, to amplify community desire, and to align activities and their activities with national malaria control programs national strategy. Our goal of working with the COCEMA is to assure that the community takes a leadership role in order for them to gain skill and capacity to continue running more learning activity even if we cease to exist."

Mosquito Net Use

"In 2018 after the mass net distribution a big number of people were using nets for fishing so the COCEMA during their meeting decided that whoever was found using a net, it would be confiscated and the person would be taken to the chief's house for further education and a volunteer was assigned to them help hang the net and to follow up the net hang during their regular visits to the households," Nelo said.

According to him, COCEMAs are sustainable. To prove their sustainability, in 2019, when the southern part of Angola was affected by drought and crops died so most of the community members especially the youth were leaving for Namibia to seek greener pastures and most of COCEMA volunteers are actually part of this group so the COCEMA and volunteers decided to meet and concluded that whoever was leaving to Namibia would select someone from the community that will be trained by field officers and monitors driver to keep the malaria activity running until the volunteer returns take over their activity. So during this period, the community kept malaria activities running because they understood the importance of the program.

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