Health Poverty Action
Improving Malaria Prevention and Control Together (Impact)
Bombali district has one of the highest malaria prevalences in Sierra Leone. When Ebola struck in 2014, Bombali was hit particularly hard and several health staff died or quit. In 2015, the Ebola hotspots of Bombali and Port Loko were declared to have the highest malaria rates in Sierra Leone, but the lasting fear and mistrust of the health system that emerged from the Ebola crisis led to a sharp decline in utilisation of health services.
This project aimed to work with local community groups to dispel myths about malaria, increase awareness of the importance of seeking care, and to increase access to malaria services. The project mostly targeted pregnant women, teenage mothers, as well as children under 5 in the 10 most remote chiefdoms of the Bombali District.
325 community health workers were trained to conduct rapid malaria testing in communities and refer cases to health facilities. This was done as part of the project’s work to increase the integration of effective malaria care within existing maternal, child and youth services.
Health Poverty Action also worked with the communities to improve their involvement in how health services were delivered and supported the Ministry of Health and Sanitation with policy formulation, as well as data collection and reporting.
One of the project’s most significant achievements is that it had a direct impact on the reduction of malaria prevalence within Bombali and Karene districts across both adult and child populations. This achievement was partly credited in the mid-term evaluation to the improved quality of the Ministry of Health and Sanitation’s malaria services in terms of the “increased testing of suspected malaria cases, improved first-line anti-malarial treatment of confirmed cases and introduction of intermittent preventive treatment of malaria during pregnancy (IPTp)”.
Alongside this, knowledge on malaria and health seeking behaviour had also improved in the target area. Improvements were also noted in data collection, analysis and sharing, with the number of health facilities reporting complete malaria data at the scheduled frequency.
Working with existing community structures
Such as school health clubs, village development committees, community health workers and ambulance committees helped significantly, serving as effective platforms for malaria-related community engagement, prevention and support in hard to reach areas. Therefore, continuous coaching and capacity support to community health workers serves as best practice that can improve and sustain the reach of malaria prevention programmes in hard-to-reach communities.
Integration of malaria programming into reproductive maternal child and adolescent health services
This was a notable policy largely contributing to a reduced prevalence and fatality case rate — especially among under-five children and pregnant women/adolescents in the district.
Localisation of services
Communities became more motivated and appreciative of the services of community health workers and health facility staff when they saw greater utilisation in their local area
-23%: the reduction in the prevalence of malaria in Bombali and Karene districts compared to a 5% estimation of the national increase in the same period.
+62.4%: change from baseline to midline in the proportion of pregnant women, teenagers and U-5s with fever in the last two weeks for whom advice or treatment was sought from a CHW or health facility.
71%: proportion of Peripheral Health Units (PHUs) staff who placed high importance on the use of malaria data derived from health management information systems (HMIS) for decision-making at both community and district level.
+12.3%: change from baseline to midline in the proportion of children under five years old who slept under an ITN the previous night.