Advancing the Community-Focused Fight Against Malaria in Guinea

In the past five years, Guinea has made tremendous progress in malaria control, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. These gains were driven by the rapid scale-up of malaria prevention and control interventions, led by the country’s National Malaria Control Program (NMCP) and supported by initiatives such as the U.S. Agency for International Development (USAID)-led U.S. President’s Malaria Initiative (PMI).

Despite this progress, malaria remains the most burdensome communicable disease in Guinea, a French-speaking coastal country in West Africa. Malaria—paludisme in French—is the leading cause of health consultations, hospitalizations, and deaths in Guinea.

“Stop Palu” through Prevention, Diagnosis, and Treatment

To help Guinea meet ambitious malaria reduction goals, in 2013, USAID launched a project called StopPalu with funding from the President’s Malaria Initiative. In 2017, RTI was awarded the StopPalu+ project to continue to support the government of Guinea in its efforts to drive down rates of malaria in the country.

Operating in half of Guinea’s 38 districts, StopPalu boosted local capacity to prevent, diagnose, and treat malaria. StopPalu+ continues this effort, supporting the distribution of long-lasting insecticide-treated bed nets, providing seasonal malaria chemoprevention, and building the Ministry of Health’s capacity in malaria diagnostics.

Technical assistance and training under StopPalu resulted in measurable gains, including

• The national malaria prevalence decreased from 44 percent in 2012 to 15 percent in 2016
• The percentage of households with at least one insecticide-treated bed net went from 46 percent in 2012 to 84 percent in 2016
• The percentage of fever cases tested for malaria was 100 percent in 2017, compared to 89 percent in 2013
• More than 99 percent of health facilities submitted monthly malaria reports in 2017, compared to less than 30 percent in 2012.

A Community-Driven Approach to Fighting Malaria

Under StopPalu, we helped train more than 1,400 volunteer community health workers (CHWs) in a set of skills known as “malaria community case management.” These skills include

• Use of rapid diagnostic tests to confirm whether a patient with a fever has malaria
• Administration of the most effective antimalarial medicines available today—artemisinin-based combination therapy or ACT—to treat diagnosed cases
• Referral of severe malaria cases to health facilities.

In early 2016, we helped reach nearly 1 million households with more than 3.3 million insecticide-treated bed nets. Community health workers were instrumental to the campaign’s success. They not only helped identify and count households targeted by bed net campaigns, but also assisted in hanging the nets and checking to ensure they were being used correctly.

Under StopPalu we also supported social mobilization and education activities—developing trainings as well as radio and television campaigns—to promote the proper use of nets, early diagnosis, and treatment-seeking behavior. 

Adapting through MERLA

StopPalu+ is using information and evidence to gather lessons and continuously adapt the project’s efforts using a MERLA (monitoring, evaluation, research, learning, and adapting) approach. For example, data on locations with high malaria incidences have helped the project focus activities in the place where they would do the most good. The MERLA approach uses monitoring and evaluation data as more than a reporting requirement; instead, it leverages programmatic data and adds operational research findings to drive planning, decision making, and implementation.

Continued Focus on Community and Local Partners Drives Sustainability

StopPalu+ is building the capacity of, and working through, five Guinean nongovernmental organizations with demonstrated PMI program results in social and behavior change communication, social mobilization, and support to community health workers (CHWs).

Our partners are involved in all aspects of the project—from supporting CHWs in conducting door-to-door visits to monitoring the regular and correct use of LLINs, to disseminating key messages on preventive treatments and malaria case management, to collecting data to inform decisions.

The project also regularly conducts community dialogues to share what it has found during home visits and to recommend positive actions that improve health and well-being.

These dialogues help gather first-hand descriptions from the community members and leaders about the barriers they face in terms of using malaria products and services, and about their greatest challenges in the fight against malaria. In addition, they help community members feel they are part of the solution for malaria control and prevention and build trust in the project and the prefectural health officials, helping increase sustainability and self-reliance.

Supporting a Flexible Reaction to Ebola

In March 2014, when the largest outbreak of Ebola began in West Africa, Guinea was one of the hardest-hit countries—with more than 3,000 confirmed cases and 2,500 associated deaths. In addition to the toll on human life, the epidemic disrupted the delivery of health care and education and created significant security issues throughout the country.

Community health activities under StopPalu were also seriously affected by the Ebola epidemic. Visits to health facilities dropped dramatically because community members feared contracting Ebola, facilities closed, and some community health workers resigned. In the 14 districts supported by StopPalu, the number of home visits dropped from 36,956 (July to September 2014) to 19,481 (October to December 2014).

StopPalu supported the NMCP in adapting to this difficult and complex context. We helped revise Guinea’s malaria case management protocol according to recommendations from the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization, training 1,041 health facility workers on the new protocols. Home visits in StopPalu-supported districts bounced back quickly—increasing from 19,481 (October to December 2014) to 37,026 (July to September 2015).  

After the Ebola outbreak ended, Guinea’s Ministry of Health began overhauling the health system with an eye to strengthening services at the community level. With its strong ties to local nongovernmental organizations, established presence in communities, and reputation as a trusted partner, StopPalu offered a blueprint for going forward, and a base from which to build.