Using SBCC to End Malaria for Good

Monday April 25th marks World Malaria Day, a day in which the global community comes together around the theme “End Malaria for Good.”  To continue with our 2016 World Malaria Day blog series, I interviewed to Anna McCartney-Melstad, Health Communication Capacity Collaborative (HC3) Nigeria Chief of Party and Roll Back Malaria Communication Community of Practice Co-Chair, about her thoughts on malaria elimination and how social and behavior change communication (SBCC) can best support elimination efforts.

Malaria Control vs. Malaria Elimination SBCC Strategy: An Ocean Wave vs. a Squirt Gun

Voices for Malaria Free Future, Johns Hopkins Center for Communication Programs

Voices for Malaria Free Future, Johns Hopkins Center for Communication Programs

According to McCartney-Melstad, one of the biggest differences between strategizing for malaria control and elimination is the need to get personal. “Approaches for malaria control are like an ocean wave,” she explained, “Your efforts are broader. You can’t focus on the individual cases, so you target larger groups and push them to adopt general evidence-based prevention and treatment strategies. For example, you work with providers to get them to test before treating clients. You focus on places with high burden.”  However, once a country has elimination in sight, it must design programs around low burden areas, switching its focus from macro to micro levels. SBCC for elimination can be challenging because it requires getting all residents on board with continuing to practice healthy (but sometimes burdensome) malaria behaviors at a time when the perceived threat of malaria is low. Residents may not be as motivated to routinely remove all the furniture from their house for Indoor Residual Spraying (IRS) or get tested when they do not feel sick. This often coincides with a decrease in political interest due to other health issues that are more visible or have a higher burden on the health system. Targeted community and individual outreach activities regarding why a particular areas needs their citizens to practice continued prevention and treatment behaviors is necessary to address their unique questions and barriers, and get them on board with activities that require their participation, like case surveillance and treatment.

McCartney-Melstad also added that SBCC programs should adapt their communication directed at providers as a country approaches elimination. At this time, doctors may to brush off malaria as a possible diagnosis and send patients home with an ineffective treatment, like paracetamol or an antibiotic, assuming the fever is caused by a virus or infection. Doctors from countries with mandatory reporting requirements should be reminded to test, treat as appropriate, and report all malaria-positive cases to appropriate authorities.

Strengthening efforts through cross-border initiatives and partnerships

“Coordinating  SBCC for elimination is quite different than coordinating SBCC in control because of the types of partners you need to engage,” explained McCartney-Melstad. Countries with sharing borders with malarious countries that employ large numbers migrant workers need to engage stakeholders from bordering countries, as these populations may carry the malaria parasite back after a weekend or holiday back home. Partnerships with national border control and migrant organizations, like the International Organization for Migration, can provide solutions that expand beyond the reach of SBCC campaigns which end at a country’s border. She also pointed out that Southern African countries have done an excellent job bringing together health ministers as an opportunity to discuss strategies and sign bilateral MOUs through SADC. Program coordinators should be thoughtful that the tone of these meetings is positive and productive, and does not become a chance for country representatives to blame each other and instead leveraging off the other’s resources.

Partnering with the private sector can also create opportunities that go beyond the reach of border control or migration specialists. McCartney-Melstad mentioned that some countries have piloted rapid diagnostic tests (RDTs) and treatment for positive results for those crossing the border by land, but these requirements have little impact on identifying populations who illegally enter the country. One way to overcome this challenge is by working with private sector employers, like agriculture companies employing migrant or cross border employees, who can ensure proper screening and treatment when necessary for those returning from the high burden country.. Communication with the private sector should show how the partnership will be beneficial to their own return on investment, and not just the larger cause. For example, highlight that employees will be more productive and valuable if they are healthy and able to work at their full capacity.

Advocacy! Advocacy! Advocacy!

Malaria elimination comes with two main challenges. First, malaria elimination activities – like improving national surveillance systems and trigger chains or conducting house-to-house case detection and treatment – are more expensive than malaria control activities. Adding to this challenge is the fact that key health decision makers tend to become less focused on malaria, and more willing to invest in other health outcomes that seem more urgent, as malaria becomes less prevalent in their country. As such, malaria professionals must join together during pre-elimination to advocate for the benefits and justify the cost to decision-makers. They also need to develop strategies to convince residents to keep practicing positive health behaviors to prevent resurgence.

What is your country doing to “end malaria for good?” Does your organization have experience conducting SBCC for elimination?  Join moderators Andrew Tompsett (PMI), Mike Toso (HC3), Rebecca Shore (VectorWorks) and Bill Brieger (Johns Hopkins University) for a conversation on April 25-26 – has social and behavior change communication been integrated as part of the solutions and strategies needed in the malaria fight to the final mile to elimination? If not, what needs to done?

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