Phalombe Malaria Communities Project

1. Phalombe Malaria Communities Project 13th AUGUST 2010 Themba Phiri Project Director

2. QUOTE “Today we have begun to write the final chapter in the history of malaria. We have raised hopes and expectations of our people-we must not let them down. We cannot afford to let them down.” HE. Olusegan Obasanjo, former President of Nigeria, Abuja Summit 2000.

3. GOAL: Reduce malaria associated mortality and morbidity by 50% (form 62% at baseline to 31% morbidity and form 900 – 450 mortality) by September 2012

4. Primary Target Population • 60,000 Care takers of under five children • 15,000 Pregnant women • 60,000 Adult men • 2,000 PLWA

5. Secondary Target Populations • 30 Traditional healers • 43 Traditional Birth Attendants • 460 Village Leaders • 300 Health Workers • 60 Religious Leaders • 5 Traditional Authorities • 35 Political Leaders (5 MPs)

6. Linkages to national strategy • Malaria Communication strategy aims to: • Empower communities; 23 CBOs, 20 FBOs, 5 ADCs, 46 VDCs • Create demand among 85% of community members for information and malaria control services • Increase depth of knowledge about malaria prevention to 85% • Increase coverage of social behaviour change and communication to 85% of target groups • Stimulate community dialogue, discussion and action on malaria amongst 5 radio listening clubs, 460 community leaders and 4600 volunteers

7. Linkage of project to Malaria communication strategy • Project objective 1 links well with third, fourth and fifth aims of the communication strategy • Project objectives 2 and 3 are directly linked to the second aim of the communication strategy whilst the fourth project objective is directly linked to the first aim of the communication strategy • The national malaria strategic plan 2005 – 2010 has four strategic areas that are directly linked to the project and these are;   • (i) improve community and family practices for malaria case management; • (ii) maximise reduction of malaria in pregnant women through the use of IPT; • (iii) maximise reduction of malaria through appropriate use of ITNs and other vector control measures; and • (iii) strengthen IEC for malaria control

8. KEY BARRIERS TO ACHIEVING BEHAVIOURAL CHANGE • Myths and misconceptions about malaria and treatment: (Source; Baseline survey report; Phalombe Malaria Com. Project- 2009) • Malaria is caused by witchcraft therefore only herbalists can cure the disease • Sleeping under a net makes you impotent • Insecticides that are used in ITNs are harmful to infants • Other challenges emanate from fears and perceptions of malaria and services provided, such as: (Source; same as above) • Fansidar SP may cause abortion in pregnancy • Once the fever and symptoms of malaria cease, one is fine and it is no longer necessary to continue taking the medication and when you do not see or hear the mosquitoes, you do not need to use the ITNs pared Communities

9. KEY BARRIERS CONT.. • Behaviour challenges emanating from inadequate knowledge • There is poor knowledge on dose regarding the new LA regimen • Some mothers do not know the frequency of taking SP during pregnancy while others do not know the importance • Poor health service delivery system and infrastructure • Long distance to nearest health facilities affecting attendance at ANC and health seeking behaviour • Congestion at health facilities • Poor health worker attitude • Frequent drug and ITNs stock outs

10. Interventions addressing BARRIERS MASS MEDIA: Branded campaign and messages, interactive radio, uniting all malaria initiatives • ADVOCACY: • At national and local level to raise attention to taking charge of malaria SOCIAL MOBILIZATION Empowering communities to take charge of malaria Marketing Malaria Prevention Communities

11. Mass Media • Conduct 736 Malaria community campaigns and road shows and reach out to 184,000 people per annum • Strategic use of community/national radios through dialogue sessions, news bulleting of malaria events, mass campaigns, malaria songs etc.. • Market Malaria Prevention communities: villages showing best practices on malaria prevention i.e. Over 85% of HHs in a village owning ITNs and using correctly. These will be given airtime on the radio to present their experiences and leaders in the villages will conduct tours to other villages for peer education purposes (act as an incentive) • Print 30,000 IEC materials for a low literate audience • Wall branding at 14 Health Facilities and 6 trading centres • Use of news papers through features and documentaries of best practices

12. Cycle for malaria campaigns lead by DC and Secretary for Health and road shows reach out to thousands of people with malaria messages

13. Advocacy Make malaria action part of national ion • Work with 35 key political leaders at district and community levels to advance malaria policy issues to parliament. • Hold 10 events and debates with politicians, Traditional Authorities on issues requiring formation of by-laws that could safeguard abuse of ITNs, malaria drugs and other supplies • Identify 2 Malaria Ambassadors (1 male and 1 female) within the community who are role models for in community to disseminate malaria prevention messages through campaigns, IEC materials, radio, wall brandings, bill boards etc: The project has identified the District Commissioner as the malaria ambassador so far and has printed posters depicting him and his child with a message that encourages men to take part in seeking care for their U/5 children once they show signs of malaria – see poster below)

14. Malaria Ambassador Emanuel Bambe - DC for Phalombe District Mr Bambe has been depicted on 600 posters in a malaria campaign to encourage men to take part in care seeking practices when their children have fever and encourage their pregnant partners to start attending antenatal clinics. Mr Bambe has also been instrumental in encouraging the general community to consistently use ITNs and seek care for malaria at health facilities

15. Social Mobilisation Communities • Orientation and Training of community structures i.e. 46 VDCs, 5 ADCs, 460VHCs, 23CBOs • Development of a community activities and education tool kits; • Community monitoring and evaluation through quarterly review meetings with volunteers, health workers and leaders • 46 Participatory drama performances per quarter reaching out to 46000 people quarterly with malaria messages • 5000 Home visits per quarter where demonstrations for net use and education sessions are conducted Interactivity leads to action

16. Mainstreaming for Scale

17. Capacity Building Build capacities to design and implement social and behavior change communication • Conduct training needs assessments • Developed a tailored curriculum for community malaria prevention education and BCC training curriculum • Train 300 front line health workers, 4600 volunteers and 20 extension staff from government departments engaged in malaria control • Train of 40 indigenous organisations in malaria prevention and message dissemination to communities they serve

18. Community campaigns on ITN use using drama and demonstrations is an effective means of message dissemination to illiterate communities which are over 70% of the population

19. Standard indicators Community participatory Monitoring BASIC BEHAVIOR CHANGE EVALUATION FRAMEWORK PROGRAM ACTIVITIESprocess indicators - # of health prof trained in malaria BCC - # of radio shows aired - # of schools reached - etc. EXPOSURE TO INTER-PROGRAM - # heard radio spot - # saw drama - # participated in community program - etc. CHANGE IN BEHAVIORAL DETERMINANTS - For example, Increased knowledge about malaria treatment, prevention, and control; attitudes, perceived risk, outcome expectation, norms CHANGE IN BEHAVIOR - Increased use of ITNs - Increased use of HF for early diagnosis & treatment - Increased attendance at ANC - Increased IRS rates & lowered re-plastering rate after IRS CHANGE IN CLINICAL INDICATORS - Decreased malaria morbidity and mortality Monitoring and Evaluation

20. Coordination