The winning formula to beat malaria - World Malaria Day report
There is growing scientific evidence to demonstrate that combining mosquito net distribution with follow-on "hang up" campaigns carried out by trained volunteers in the community significantly reduces incidences of malaria. Combining distribution with follow on support and training is especially crucial to reach the most vulnerable groups (such as those living in remote areas, refugees, people affected by stigma and discrimination) who cannot be otherwise reached by mass education campaigns. Trained volunteers who live in the very same community as the beneficiary population and speak the same local language are ideally placed to help families overcome any social or cultural barriers that could prevent the effective use of nets. Since 2002, as a direct result of net distributions carried out by National Red Cross and Red Crescent Societies supported by the IFRC, more than 289,000 malaria deaths have been averted, while 17.5 million people have been better protected against malaria.alaria. Since 2002, the distribution of long-lasting insecticide treated mosquito nets has increased ten-fold in sub-Saharan Africa. This has been made possible thanks to the mobilization of the international community of organizations and donors that united to stop malaria once and for all. Yet malaria is still killing nearly 1 million people every year, mostly children under 5 years old, even though it is completely treatable and preventable. Because malaria-carrying mosquitoes bite from dusk to dawn, long-lasting insecticidal mosquito nets provide the best known means of effective protection. The IFRC's pilot efforts in Ghana, Zambia and Togo between 2002 and 2004 helped demonstrate to the world's public health community that free distribution of nets was the most effective and efficient way to meet global goals, and that such large-scale efforts were logistically possible, in part through the coordinated support of thousands of volunteers mobilized by Red Cross and Red Crescent societies working in partnership with their Ministry of Health national malaria control programmes.
The malaria programmes being implemented by Red Cross and Red Crescent societies will contribute to achieving the Roll Back Malaria 2010 targets: 80 per cent of people at risk from malaria are protected; 80 per cent of malaria patients are diagnosed and treated within one day; the malaria burden is reduced by 50 per cent compared with 2000.
Skilled volunteers, not just manpower
Volunteers have played, and will continue to play, a valuable role in providing additional manpower during mass distribution campaigns. However, they are doing much more than that. They have been undertaking key activities to complement the distribution of nets. These aim to promote better understanding of the risks of malaria and more information on how to effectively prevent malaria. Crucially, volunteers also carry out the personal followup household visits that the IFRC calls "hang up" campaigns. This clearly means that volunteers are not only manpower but above all trained community resource people with specific skills to give support, training and empowerment to their communities.
The hang up campaigns
Volunteers go into action in all phases of the campaign: before, during and after the distribution. Before the campaign, Red Cross and Red Crescent volunteers make sure their local community is aware that the distribution is taking place and that families should go and get a free net. They ensure that families know where to go for the distribution, when it will take place and who the key beneficiaries of the activity are. If the campaign is integrated (for instance combined with an immunization campaign for polio or measles), they also make sure families understand how essential it is to take their children to the vaccination centre to be immunized. The second action takes place during the campaign itself, with volunteers assisting with the logistics and distribution of the nets. During the campaign, volunteers continue de follow up with community members to ensure that they have benefited from the interventions being offered by the Ministry of Health.
The third action is the hang up campaign itself. Hang up activities may take place just after the distributions, a few days later or just before the start of the rainy season. During the hang up phase, the same volunteers undertake house-to-house visits to make sure community members understand the malaria threat.
They also check that families and community members know how to use the net. If not, they will help the family to set up the net correctly. Red Cross and Red Crescent volunteers insist that the most vulnerable members of the family be prioritized for sleeping under the net: pregnant women and children under the age of 5 are at highest risk of sickness and death from malaria.
In some cases, hang up campaigns lead into more comprehensive longer-term "keep up" activities to promote net ownership and usage, completion of the childhood routine vaccination series, attendance of pregnant women at ante-natal care clinics and prompt and effective treatment of fevers within 24 hours of onset of symptoms.
Whether they are involved in hang up campaigns or keep up programmes, one of the main advantages of volunteers is that they live in the very same community that they serve, which means that they can talk to beneficiaries using the local language and with an understanding of the community context. They are also fully aware of the cultural barriers that might prevent the use of nets by the family members and are often better placed to identify the most vulnerable members of the community.
The IFRC believes that empowering communities is as essential as the distribution itself, since giving a net together with the provision of information to the community and demonstrating how to use mosquito nets correctly considerably increases the impact of the distribution campaign.