Fighting Malaria in Cabo Delgado, Mozambique
Malaria is one of the major causes of morbidity and mortality in Mozambique. Among all of the provinces, Cabo Delgado has the highest prevalence of malaria with 57%. Malaria creates a high burden of care for already overwhelmed health facilities. In Cabo Delgado, malaria accounts for 28% of the total number of consultations.
Pregnant women and children under 5 years are most vulnerable to malaria, in fact, children 0-5 years were the most affected age group with just over half of all infections in 2015. To combat these challenges, CUAMM in partnership with Wiwanana Foundation led this project in communities surrounding a total of 8 health facilities in Montepuez and Balama Districts in Cabo Delgado. The project covered 64 communities all located over 7 kilometres from the respective health centre. The project focused on women of reproductive age and on caregivers of children under 5 years. The project had three main objectives:
Improve knowledge about malaria, prevention and the importance of diagnosis and rapid treatment in 8 health areas in the Balama and Montepuez Districts;
Improve malaria prevention behaviors at the community level and demand for malaria treatment in vulnerable groups in 8 health areas in Balama Districts and Montepuez
Improve the quality of malaria prevention and treatment services in 8 units of health in the districts of Balama and Montepuez
Overall, the project was able to increase in knowledge about malaria and increase the speed at which health services were sought for children with a fever. The most significant achievement of the project however was the increased coverage of Isoniazid Preventive Treatment (IPT) in the rural communities targeted. At the end of the project, more than one third of women could mention IPT as a form of malaria prevention in pregnancy (up from 0.6% to 37.4%) and approximately 80% of pregnant women received at least 2 doses.
Adopting an integrated approach
A key success factor was the integrated approach, aiming both at demand creation and service provision. It was also the result of the partnership of two NGOs (Fundaçao Wiwanana and CUAMM-Doctors with Africa) simultaneously working at two different levels (community and health sector) in a complementary way with the collaboration of local health authorities.
Community empowerment and accountability
In addition to stockouts of medication, respondents involved with the project evaluation reported poor care from many of the health facilities ranging from ilicit charges, to disrespectful staff and extremely long waiting times. These challenges highlight the need to incorporate advocacy into social and behaviour change interventions. While there was improvement in health seeking behaviour at the end of this project, this will not continue if services are routinely unavailable