Community - Asian Collaborative Training Network for Malaria

Objectives of presentation
• To communicate learning
experiences on innovative
approach in malaria
prevention and control
• To illustrate that community
based malaria surveillance
and vector control can be
attained and contribute to
incidence change

• Malaria is an antique
disease that affects man
since ancient times
• Worldwide: 300 to 500 M
cases, and 1.5 to 2.7 million
deaths each year…

Concerns on MCP
Only one Rural Malaria
Coordinator in the
municipality …
* could not cover all endemic
villages to conduct
surveillance, health
education, and vector
control activities

Concerns …
Community:
• Poor understanding of
malaria prevention and
control …
* very few households use
bednets (“katol”)
* regard malaria as “Flu”
(do not seek consultation)

• Community:
Concerns …
• Far-flung villages
- poor access to services
* self medication, and just
wait until fever subsides
• Transient small-scale miners
(no bednets)
• Presence of ethnic minorities (no
bednets, hammoks and bonfire)

Masbate
.07%(4)
Malaria Incidence, Region 5
by province, 1987 (n= 5,521)
Camarines
Sur
15%(805)
Catanduan
es = 0
Sorsogon
.89%(49)
Albay
1.04%(64)
Camarine
s Norte
83%(4599)

18%
Panganiban
26%
Paracale
16%
Labo
18%
22%
Basud
8 Mun

Annual Parasitic Incidence,
target villages, J. Panganiban, 1987
VILLAGES
API
Osmeña 111
Bagumbayan 88
Sta Rosa Sur 82
Luklukan Sur 67
Sta Rosa Norte 52
Luklukan Norte 34
AVERAGE 72.3

MASUVECCO
•was conceived to augment
Malaria Control Program
•Objective: To reduce
malaria incidence by 75%
in 3 years through
TOTAL COMMUNITY
INVOLVEMENT

Strategies
1. Social Mobilization
2. Capability Building
3. Community based
Malaria Surveillance
and Vector Control

1. Social Mobilization
• Core groups of volunteers
were organized in every
purok of the 6 highly
endemic villages
• Volunteers identify their
roles in the project
• Partnership Building

2. Capability building
Enhance knowledge/attitude
Lecture and discussion on:
Malaria
* as a disease, and
* its socio-economic impact
The Vector Mosquito
* biting / flying / resting
habits, breeding places,
harborage, & vector control

Capability…(con’t.)
Skills Training:
Perform malarial smear
Dispense anti-malarial drugs
Mass treatment of bednets
and curtains, and
How to organize
Household Malaria Classes

Capability…(con’t.)
Logistics:
MASUVECCO Volunteers
were then provided with
anti-malarial drugs and
complete paraphernalia

The MASUVECCO Volunteers
proudly positioned themselves
in their own villages to
conduct
surveillance, health education,
and mobilize their neighbors
for vector control.

3. Community based Malaria
Surveillance & Vector Control
Surveillance
Active and passive case
finding
* Identify suspects, take blood smear
* Dispense anti-malaria drugs
* Notify clients of results of smears
Screen travelers coming in
& out of their villages

Community based malaria
surveillance and vector control
Vector Control
Mobilize community for:
o Stream clearing and seeding
(Gambucia / Tilapia), and
o Mass bednet treatment
(families were encouraged to treat their
own bednets)

Other activities
• Health Education:
Household Malaria Classes,
distribute flyers & posters
Small group discussions
(pulong-pulong)
• Recording and reporting
• Quarterly assessment of
accomplishment and semiannual
evaluation (awarding)

• DOH-JVOFI Collaboration:
Training and Mobilization
funds
• Regional Health Office and
Provincial Health Office:
Replicated the project in all
endemic municipalities in
Region 5 (and in other
endemic regions)

• DOH-Malaria Control Service:
Logistic support:
Permethrine, anti-malarial
drugs, slides, cotton,
pricker, stain
Technical support:
Insecticide treatment of
bednets, CBT

• Department of Education,
Culture and Sports:
Included topic of Malaria in
science subject
Village teachers serve as
advisers in Household
Malaria Classes
Conducted poster and
slogan making contests

• Municipal/Barangay Gov’t:
Mobilize local officials
and community
Erected billboards in each
village
• Plan Bicol International:
Donated bednets to indigent
families
Training funds
(14 core groups)

Project Partners
• Association of Small Scale
Miners:
Mobilize their workers for
stream clearing / seeding
Transportation for
volunteers

Results
Total community involvement
in Malaria surveillance and
vector control
Early diagnosis and prompt
treatment
* MASUVECCO volunteers
present in every village,
* attend to cases
immediately

Results …
76 % reduction of API in
the 6 target villages
80% Reduction of Positive
cases in Jose Panganiban
(from 720 in 1987 to 138
in 1993) (Annual Report, RHU J.Pang.)
83% Reduction of positive
cases in 5 replication Mun.

Comparative API,
target villages, 1987 & 1993
BARANGAY API API %
1988 1993 Reduction
Osmeña 111 40 64
Bagumbayan 88 12 86.4
Sta Rosa Sur 82 11.4 86.1
Luklukan Sur 67 22.5 66.4
Sta Rosa Norte 52 2.8 94.6
Luklukan Norte 34 13.8 59
AVERAGE 72.3 17 76 %

Cases
8000
7000
6000
5000
4000
3000
MASUVECCO
2000
1000
0
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995
Y e a r
Albay Camarines Norte Camarines Sur
Catanduanes Masbate Sorsogon
Region 5

Lessons learned
The community is our
strongest partner …
* they should have more
meaningful roles
* not just
beneficiaries

Lessons learned
Determination to have a
healthy community can
be a strong motivation
for community members
to get involved
* even without
monetary
remuneration

Lessons learned
Community organizing
must start from the
grassroots level
*The people organize
themselves…
* Health personnel provide
technical support to make
their business systematic

Lessons learned
Intra/inter-sectoral
collaboration is vital in
any community based
health program

Conclusion
An empowered
community, working in
partnership with DOH,
Local Government
Units, and NGOs can
influence disease
incidence in a locality.

Limitations
This project was conducted
without formal baseline
study such as KAP survey,
Entomological survey, and
knock-out property of
chemical
* thus difficulty in doing
evaluation.

Limitations
There was no post-study
such as Vector response to
chemically treated bednets
(resistance to chemical,
biting times and sites, peak
biting periods, etc.)
No control community