If good health systems are put in place, enough funding for prevention is guaranteed and leaders are fully committed, then the war on malaria is bound to be won.
Usually, it is individuals who decide to use or not to use insecticide-treated mosquito bed-nets, spray insecticides indoors or not. This is also true when it comes to going for malaria testing and treatment if necessary. Clearing bushes and stagnant water to get rid of mosquito breeding grounds around homes is still discretionary in most communities.
One may ask: What if there were an option to coerce people to take preventive measures: wouldn’t that work? Well, studies have shown that in public health interventions such as these, coercion is indicative of failed leaderships.
People-centred or community-based collaborations are touted as workable models for building trust in campaigns that require the uptake of certain interventions, such as spraying homes, applying repellents or using bed-nets that have been treated with the right chemical substances.
Coercion can’t be part of the equation.
It was thus encouraging to learn that this year’s World Malaria Day (WMD), to be commemorated on April 25, has adopted the people-centred slogan ‘Zero malaria starts with me’ to brand the international day observed every year to recognise global efforts to control malaria.
Over 17 years ago, a World Health Organization report titled Communication for Behavioral Impact to Roll Back Malaria detailed why engaging individuals and communities in a meaningful way can inculcate positive health behaviour to sustain efforts being taken to curb malaria.
But, for that to happen, the report says, “[It] requires a focused, clear strategy on how to identify, persuade and convince individuals and groups that taking appropriate action to prevent malaria and/or seeking the right treatment early enough is worthwhile.”
Zanzibar offers good lessons – not necessarily for copycat interventions where we live, but on why the focus should be on the people as potential victims.
The Zanzibar Malaria Elimination Programme (ZAMEP) has managed to keep prevalence of the disease as low as less than 1 per cent since 2010, reaching up to 0.003 per cent in recent years.
ZAMEP owes this success to community sensitization and household surveillance of the disease, together with the treatment of all cases, emphasis on use of insecticide-treated bed-nets and indoor residual spraying.
But above all, the people were willing enough to deal with the disease as individuals.
Currently, 90 per cent of the population in Tanzania lives in areas that carry a high risk of malaria transmission, says the National Malaria Control Programme (NMCP).
At the global level, WHO now says that, after more than a decade of steady advances in fighting malaria, progress has levelled off. Based on the 2018 World Malaria Report, it appears that no significant gains were made in reducing malaria cases in the period 2015 to 2017.
But, there are bad and good examples of countries vis-à-vis the malaria scourge. Rwanda has seen the greatest increase in malaria cases since 2016 – around 1 million – while Madagascar has the greatest decrease: more than 800,000.
In that same year, Senegal and Sri Lanka showed that beating malaria is possible. Sri Lanka was certified as malaria-free by WHO in 2016, a milestone largely achieved through domestic financing.
Senegal saw its malaria cases decrease by more than 250,000 since 2016. A nationwide malaria campaign, ‘Zero Malaria Starts With Me’, was adopted in that country early to engage Senegalese to keep malaria high on the agenda.
It’s our time in Tanzania, let’s start today; let’s ‘Get it Done!’