In Mozambique, malaria accounts for 29% of all deaths and 42% of deaths in children less than five years old. People in rural areas are twice as likely to catch the disease than those in urban areas. Many don’t know about the dangers of malaria, how to prevent it or treat it. Poor access to health care and low-quality services prevent them from seeing a health worker when they’re sick.
Nampula is one of the most populated provinces with poorer health outcomes than most. According to the 2018 Mozambique Malaria Indicator Survey, Nampula has the highest prevalence of malaria, 48% in children under 5. The Netting Malaria Project aimed to build awareness among rural communities about the dangers of malaria, how to prevent it and where to get treatment.
The Netting Malaria Project worked with local communities to encourage behaviour change. N’weti worked with community-based organisations (CBO’s) and trained the facilitators in malaria behaviour change interventions such as group dialogues, home visits, referrals and counter referrals, community theatre and the community score card interventions. As well as training community organisations of behaviour change techniques, they also taught organisational skills and encouraged organisations to widen their influence and speak to the whole community and with health centre staff.
The Netting Malaria Project excelled in the three project objectives of increasing malaria knowledge, increasing demand and access to timely malaria tests and treatment, and increasing citizen demand for quality health services and transparency of service providers. In addition to achieving results in the three project objectives, the project also strengthened the capacity of community-based organisations and worked to change gender norms, which will have a lasting impact on families and communities.
Empowerment through educating community members on their rights and challenging gender norms are important components of behaviour change.
Advocacy and accountability
Advocacy for improved health services is a vital component of behaviour change projects and should continue to be a focused intervention in any behaviour change project to ensure that the supply is of high quality to encourage the demand creation activities
The role of malaria focal points within health committees
Malaria causes a high burden of care at health facilities and is one of the major causes of mortality and morbidity in Mozambique, therefore there should be a malaria focal point within health committees to assist with communication between the community and health facility regarding malaria surveillance activities and testing and treatment.
Improvement in malaria knowledge - Knowledge of the cause of malaria increased from 77.5% to 94.5%. There were also increases in knowledge of malaria symptoms and prevention
Improved demand creation - 90.8% of children with a fever were taken for treatment compared to 83%. 97.4% of pregnant women attended antenatal care
Patient rights - By the end of the project, 98.3% of caregivers were given counselling by health professionals on how to give medication to their child who had a fever
Correcting bad practices - Patients are now finishing their medication and pregnant woman are going earlier to prenatal visits. The percentage of children taken for treatment within 24 hours of symptoms, moved from 61.1% to 83.8%
Changing gender dynamics - In general, the husband (or mother- in-law) decides when the mother can take the child to the health centre or go for antenatal care. N’weti is working to change these dynamics.
Dispelling myths about IPTP and malaria tests - Some women think IPTP gives them HIV or will cause an abortion. At the end of the project, 97.4% of pregnant women went for antenatal care.