12
Improving Malaria Control in Complex Emergencies

PRACTICAL CONSIDERATIONS FOR IMPLEMENTING MALARIA CONTROL

Implementing malaria control in a complex emergency generally requires concerted attention to coordination, communication, and organization because of the number of agencies involved, the fluidity with which emergency situations change, the limited consensus often seen among agencies regarding a plan of action for malaria control, and the lack of a single clearly identified organizing agency or committee to lead the effort. Criticism has frequently been leveled at nongovernmental organizations (NGOs) and the United Nations Office of the High Commissioner for Refugees (UNHCR) over poor programmatic planning, limited assessments, lack of coordination among and within relief agencies, and marginal management skills (Walkup, 1997; Seaman, 1999; Zetter, 1999). The need for a malaria control program plan that is well integrated and accepted by all participating agencies is particularly important in situations of delicate political sensitivities, such as when the malaria policy for a displaced population differs from the standard national policy.

One approach to strengthening malaria control program planning is to establish, at the beginning stages of an emergency, a joint working group whose mandate is to coordinate all primary health care services. From this larger group, a task force or committee could be formed to concentrate on how to best prevent and manage malaria. These groups should consist of



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Malaria Control During Mass Population Movements and Natural Disasters 12 Improving Malaria Control in Complex Emergencies PRACTICAL CONSIDERATIONS FOR IMPLEMENTING MALARIA CONTROL Implementing malaria control in a complex emergency generally requires concerted attention to coordination, communication, and organization because of the number of agencies involved, the fluidity with which emergency situations change, the limited consensus often seen among agencies regarding a plan of action for malaria control, and the lack of a single clearly identified organizing agency or committee to lead the effort. Criticism has frequently been leveled at nongovernmental organizations (NGOs) and the United Nations Office of the High Commissioner for Refugees (UNHCR) over poor programmatic planning, limited assessments, lack of coordination among and within relief agencies, and marginal management skills (Walkup, 1997; Seaman, 1999; Zetter, 1999). The need for a malaria control program plan that is well integrated and accepted by all participating agencies is particularly important in situations of delicate political sensitivities, such as when the malaria policy for a displaced population differs from the standard national policy. One approach to strengthening malaria control program planning is to establish, at the beginning stages of an emergency, a joint working group whose mandate is to coordinate all primary health care services. From this larger group, a task force or committee could be formed to concentrate on how to best prevent and manage malaria. These groups should consist of

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Malaria Control During Mass Population Movements and Natural Disasters representatives from any agency involved in control activities (case management, vector control, health education, water, and sanitation), along with camp officials, the UNHCR and other United Nations agencies, NGOs, the host government (especially the National Malaria Control Program, if one is in existence), the local host community, and the displaced community. This group should be convened on a regular basis, and all partners should be represented from the beginning. Each agency’s role and stake in malaria control should be clear to the other partners. ADAPTATION OF THE PUBLIC NUTRITION APPROACH TO MALARIA CONTROL Given the role that context and sociocultural behaviors play in malaria control, it is time to rethink additional ways to improve malaria control in complex emergencies. Adapting the “Public Nutrition” approach in malaria control might be an option. Using multidisciplinary approaches, registered public health nutritionists use theories of nutrition and social science to critically examine the social, political, and economic determinants of malnutrition (Borrel and Salama, 1999; Landman, 1999; Young, 1999). This approach would move the dialogue beyond standard ways of using malaria-related morbidity and mortality numbers to describe those affected by asking and attempting to answer the question: “Why are they affected?” Rather than examining only the willingness of people to engage in malaria control, this approach would also look at their ability to alter behaviors related to malaria, given the political, social, and economic constraints they face. Adapting the principles of public nutrition and expanding our understanding of the macro-level forces that affect the ability to implement quality malaria control programs will strengthen public health practices. COMMUNITY INVOLVEMENT IN MALARIA CONTROL Although use of the terms “community involvement” and “community mobilization” has become ubiquitous in public health discourses, stressing the need to have a displaced community fully represented is warranted. In the context of a complex emergency, “community” should be broadened to include four groups: members of the displaced community, members of the host community, representatives from the humanitarian relief community, and representatives of the government of the country of asylum. Each of these separate communities may have differing perspectives, interests,

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Malaria Control During Mass Population Movements and Natural Disasters needs, and priorities with regard to malaria control. It is essential that malaria control activities be developed collaboratively and that an integrated plan of action reflects the concerns and resources of all members of the involved parties. Attention to the cultural milieu of the situation, good communication, and creative approaches to integrating community participation will enhance malaria control programs. As mentioned earlier, representation on the joint malaria control working committee and use of rapid assessment techniques are two ways to involve communities. Other areas include incorporating traditional healers into clinical rounds; developing economic incentive programs, particularly for preventive measures; using community health care workers to assist with vulnerable populations; training local health care workers to interpret data they routinely collect as a first step in designing community-based control measures; and linking malaria control activities to other community-based activities that are in process and accepted. RECOMMENDATIONS Form a task force for integrated malaria control as early in an emergency as possible. Include representatives from all involved communities (host country, displaced population, and relief organizations) on the task force. Use multidisciplinary approaches to develop better malaria control strategies.