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> 4. Increasing access and building demand
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Reaching the poorest and most vulnerable people with malaria control interventions is still a largely unmet challenge. We want to ensure that we have a demonstrable impact for these populations, including women and children.
What strategies and approaches should we focus on to ensure that we reach and have impact on the poorest and most vulnerable populations?
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Our thanks for all the comments submitted. All of the ideas and suggestions put forward will feed into our new policy, helping to shape the direction of our work.
Once the final policy document is released you will be able to find it at www.dfid.gov.uk
in the short term ideally you need to make the medicine free for those in affected countries, it cost me over £200 to pay for malaria tablets for me and my children to visit Ghana, i know people that chose to go without. why can’t this be available on prescription if you really want people to not be affected by malaria and take the correct medicine? I also found that the same tablets recommended for use in Ghana was more expensive to buy in Ghana, how do you imagine the local people will be able to afford this?
Given the financial situation of hordes of people in endemic regions of Africa, and the fact that for most of them malaria is not ranking amongst their top priorities (food, safety, and income generation rank higher), it cannot be expected that these people take charge of malaria control, let alone elimination.
In the past, malaria elimination campaigns were only successful when organised in a vertical, centrally-organized manner. With the advent of the primary health care system, disease control became decentralised, which had a devastating impact on malaria control. Later this was replaced with household-level interventions (nets, IRS), which will not yield elimination. I would strongly advocate setting up of elimination brigades that are centrally organised and aim for elimination based on area-wide interventions.
Both the Government and its agencies that mediate malaria control efforts are often too far away from the realities of what they are trying to control. The absence of informed community voices in the various strategies continue to limit the ownership and participation of the people worst affected by malaria. Community-centric control strategies has the community as the focus at all stages of the eforrts undertaken. The folks know a few thing that can enhance effectiveness and sustainability of the efforts, if only someone would ask them
@John – I would appreciate knowing the ‘few things that can enhance effectiveness and sustainability of the efforts’ that are ignored.
I have never come across an example where the community itself finds solutions to a vector-transmitted disease, so am curious to know what you have in mind.
Thank you in advance.
ACTs, LLINs and even IRS teams require transport to enable them to do their work. While malaria budgets often focus on procurement or in some cases capacity building for warehouse staff, transport and distribution is often neglected leaving literally millions of (mostly rural) citizens without access to the drugs, nets or indoor spraying they so badly need.
A 2001 report titled “A Study to Determine the Key Components of a Cost Effective Transport System to Support the Delivery of Primary Health Services” highlighted the impact which improved transport can have upon health service delivery. It is our experience, from working in more than 25 countries that transport cannot be left to chance. We have seen how building the capacity of transport and maintenance managers can greatly improve vehicle availability, reduce running costs and increase vehicle life. We have studied how private sector distribution companies can be used to supplement existing government resources, and most importantly what capacity is required within government to manage such distribution companies.
We support efforts to find new solutions to old problems; research and development around net manufacture, innovative financing mechanisms or a potential malaria vaccine for example. But we also encourage development professionals to remember that such technologies will still require well managed transport, not just the decaying, ill managed and under budgeted fleets that spring to mind when one thinks of developing country Ministries of Health.
Gary Forster,
Head of Programmes,
Transaid
Vulnerability is a cross cutting development issue for different interventions like health, education, sanitation, social justice and empowerment. Hence it has to be dealt in totality with a focus on malaria. In the high burden areas following strategies could be adopted:
- Vulnerability Assessment- research- empowering such community, create a system of constant community dialogue to having better understanding on issues can be one way
- The local government (tribal self rule) needs to be established and made functional to its spirit so that health and all other issues having bearing on malaria issue can be dealth with properly
- Convergence of department and private development organisations and developing common understanding as malaria – a cross cutting issue for vulnerability intervention
A special need-based micro plan should be developed and acted upon.
Equitable access to malaria interventions is key for improving malaria control. Focussing on percent coverage is not helpful as large population centres are at low risk for malaria, thus there has to be a distinct effort to improve access to distant rural and displaced populations as these are the most at risk. Delivering control to these people will have the largest effect on morbidity and mortality both due to malaria and other diseases associated with poverty.