Participatory Communication in Malaria Control: Why Does It Matter?

"Participatory communication in malaria control matters because without genuine community understanding and engagement with the problem of malaria, external efforts will fail..."

Published by Healthlink Worldwide in its Exchange funded series Findings, this 6-page paper explores how community-level communication can engage the most vulnerable people - such as children under 5 years of age and women in the economically poorest communities in Africa - in strategies to prevent and treat malaria. It is based on the premise that current malaria control strategies rely predominantly on individuals and communities to take action to protect and treat themselves, such as by hanging insecticide-treated bed nets and (as is sometimes the case) impregnating them at timely intervals, often at the user's expense. Such strategies will only succeed, author Alison Dunn argues, if there is effective, contextual communication and genuine understanding around the causes, symptoms, and means of preventing and treating malaria: "If the bed net is not perceived as an effective intervention people are more likely to misuse, sell, exchange, discard or transform it. In Africa mesh bed nets have been turned into wedding dresses, fishing nets and water filters (Bean, 2001)."

Communication approaches to malaria control that engage with local communities in participatory ways go beyond message delivery and social marketing and move toward a genuine exchange of understanding between agencies and local people as to what will work best in the local context. Constraints to prevention and treatment are determined by complex social and cultural influences, and vary by country and region - and thus call for different approaches. Dunn stresses that communication needs to be included in the process of malaria control from the initiation of activities, not as an afterthought or add-on. This means thinking strategically about communication from the planning stages through to implementation and evaluation.

Drawing on this conception of communication's potential contribution to malaria control, Dunn cites a number of examples. For instance, to address what Dunn sees as the biggest challenge - to find a way to make people understand that they need to treat the disease malaria, not just a fever - good interpersonal communication combined with accurate information is key. One study in Uganda showed that 90% of people adhered to the right treatment when given a pack with clear instructions and advice from a health worker. However, simply providing correct information is not the solution, Dunn stresses; the quality of health care and health care providers is also critical.

Community action has been another successful strategy: "In a community in Tigray, Ethiopia, mothers act as co-ordinators to recognise and treat malaria, and childhood mortality has reduced by 40% (Kidane and Morrow, 2002)." Community-level action like this can be supported through social science (research) approaches; here again, Dunn argues that it is critical for the local community to participate in setting the research agenda. For instance, in a bed net project in N'Djamèna, Chad, a Research Action Capacity Building (RAC) approach was designed to ensure that the people intended to benefit from the results controlled the research, planning, execution, and ongoing evaluation, as well as the redefinition of activities. "Partnership and the development and sharing of ideas, concepts and activities between local people, institutions and an NGO [non-governmental organisation] saw a high number of bed nets and re-treatments sold, and improved skills and capacity in communication and negotiation (Felber, Othiquè, Yemadji and Wyss, 2001)."

Traditional information, education and communication (IEC) have been integrated into many of these initiatives, yet this strategy can sometimes fail if applied in a top-down manner that does not draw on how people use tools to engage with the local context. In general, good IEC activities are culturally appropriate, and use combined and appropriate local channels of communication (both interpersonal and media). For example, incorporating the wisdom of traditional healers into local project activities can help to prevent limited IEC impact. According to Dunn, choice of terminology is also critical in developing effective health communication interventions that relate to local people; local terms for malaria can be numerous, have sub-categories, and be in a state of flux.

Dunn concludes by referencing several toolkits and guidelines that have been developed to help programmers explore methods of participatory communication related to malaria control. In addition, Source International Information Support Centre has produced a list of key information resources on participatory communication and malaria control to accompany this paper.