The Alma Ata Declaration of Health for All in 1978 considered self-reliance and social awareness as key factors for human development and, thus, recommended the inclusion of community participation in the delivery of effective and sustainable primary health care. Through individual empowerment and social mobilization, communities will be able to identify their needs and find ways to satisfy them.
Community participation appealed to government agencies because it reduced accountability and financial investment. However, after more than 30 years of experience with this framework, more pragmatic and realistic perspectives are being presented: participation from less marginalized individuals is favored, ultimately, antagonizing the primary purpose for declaring health for all. Recently, a paper by Matsumoto-Takahashi and Kano reviewed the evidence on the value of community health workers in the prevention and control of Malaria in Palawan, Philippines. [Trop Med Health 2016; 44: 10]
Country’s improving figures
Malaria has been documented in the Philippines since 1900s with mortality rates as high as 662 per 100,000 population. Numerous strategies and programs involving various levels of government have been implemented but adequate disease control was elusive until the late 1990s. Focus on community-level participation coupled with the scale-up and integration of malaria prevention and treatment within the primary health care system have decreased the number of malaria cases by 50 percent. [WHO World Malaria Report 2011]
Kilusan Ligtas Malaria
Palawan has persistently topped the list of provinces endemic for malaria. In 1999, following the end of the Second Palawan Integrated Area Development Plan Project, an increase in malaria cases was noted. The Provincial Government of Palawan then called for proposals for a community-based malaria control project. To maximize existing resources from the Japan International Cooperation Agency (JICA), community mobilization initiatives were encouraged. Thus, the Kilusan Ligtas Malaria (KLM) or Movement Against Malaria (MAM) was established by the provincial government in partnership with the private sector.
The program identified inadequate human resource for delivery of preventive measures to remote areas as a key factor in malaria control. To help address this problem, 344 community health workers (CHWs) were trained to become microscopists. As microscopists, they are tasked to diagnose malaria in febrile patients via microscopy, to prescribe first-line anti-malarial drugs to malaria infected patients, and to implement community awareness-raising activities that aim to prevent transmission of malaria.
Determinants of effective community awareness-raising initiatives
To support the national plan for elimination of malaria, the assessment by Matsumoto-Takahashi and Kano was conducted. This study aimed to determine the value of microscopy and the active roles of CHWs in an effort to improve the community-based program. Using epidemiological data from the Provincial Health Office of Palawan and KLM main office, and previously published related literature on the CHW program, structural equation modeling (SEM) analysis was applied to determine the significant factors that contributed to the success of the microscopist’s role in the control and prevention of malaria in Palawan.
The study showed that effective community awareness-raising activities were a direct result of the microscopist’s capacity, specifically quality of service and innate ability. Of the awareness-raising information provided by microscopists, knowledge on disease transmission and knowledge on vector’s most active time were noted to be the most important factors in strengthening malaria prevention practices. Effective community awareness-raising activities also lead to appropriate treatment when patients have adequate knowledge of symptoms of malaria or live near a drug seller.
Transitioning from control to elimination
The study identified those people living in the southern region of the province, especially children under 5 years of age, indigenous people, and people who have to stay in the forest, as target groups for malaria management. The microscopists’ scope of work should then be reviewed and revised to adapt to target patients’ needs. As Palawan, and the rest of the Philippines, transitions into malaria elimination, a different set of challenges present to the health system. Proven strategies for prevention and control need to be strengthened and expanded while novel schemes need to be devised.