StopPalu+ - Community Involvement Drove Action Against Malaria in Guinea

Despite significant malaria prevention and control progress in recent years, malaria – called paludisme in French – continues to be the leading cause of illness and death in Guinea. More than 2.3 million cases of malaria were reported in this West African country in 2021 alone, with children and pregnant women being particularly vulnerable to contracting it. As part of the U.S. President’s Malaria Initiative (PMI), the USAID StopPalu+ project operated in half of Guinea’s 38 districts and 5 communes of Conakry to help the country drive down its malaria rates.

RTI Led Malaria Prevention and Control Efforts

By building on five years of progress achieved under the RTI-led USAID StopPalu project, StopPalu+ was able to quickly get to work to:

• Increase use of long-lasting insecticidal nets (bed nets) to advance universal coverage
• Increase use of preventive malaria treatments for pregnant women during antenatal care visits (ANC)
• Increase prompt care-seeking and treatment among those infected with malaria 
• Increase the number of children receiving a timely, full dose of seasonal malaria chemoprevention 
• Increase community involvement in and support for malaria prevention and care
• Improve the capacity of Guinea’s National Malaria Control Program (NMCP) to manage, implement, and monitor prevention, care, and treatment activities while using quality data for decision-making

The malaria prevention and control project aimed to not only help Guinea fight malaria today, but build capacity at all levels to prevent, monitor, and treat it in the future too. By engaging communities and building local capacity, StopPalu+ ensured the gains it helped Guinea make today will last. 

A Local Approach to Preventing, Monitoring and Treating Malaria 

To help Guinea achieve its national goal of reducing malaria by 75%, StopPalu+ partnered with local health providers and governments to provide training, tools, and support. The project trained community health workers on home visits, community case management (diagnosis, treatment, and referral of severe cases), and correct use of bed nets. It also helped local governments conduct seasonal chemoprevention and bed net distribution campaigns.

With training from the project, health providers improved case management and treatment and integrated counseling on bed nets and preventive malaria treatments during pregnancy into healthcare visits. Training and support have also helped labs improve their detection and monitoring of malaria infections.

As a result, since 2018 local governments and health providers in the PMI zone have:

• Delivered 6 million bed nets to communities
• Correctly diagnosed and treated malaria in nearly 2 million people
• Given 3.7 million doses of preventive medicine to protect 300,000+ young children each year
• Protected more than 500,000 pregnant women from malaria

StopPalu+ complemented this support with creative, multi-channel social and behavior change communication (SBCC) activities that leveraged the influence and authority of community and religious leaders to spread awareness of malaria prevention and encouraged people to seek early treatment when infected.

Examples include:

• Engaged 1,000 religious leaders to regularly spread messages about the importance and proper use of bed nets.
• Featured local community and religious leaders – both women and men – in radio and television broadcasts about malaria.
• Engaged two well-known comedians in the country to produce radio and TV broadcasts on the importance of proper bed net use within the COVID-19 context.
• Organized more than 2,300 community dialogues and advocacy meetings on malaria and other health issues, such as COVID-19.

Focus on Community and Local Partners Drove Sustainable Malaria Prevention and Control

StopPalu+ built the capacity of, and worked through, five Guinean nongovernmental organizations. These partners were involved in all aspects of the project—from supporting community health workers in conducting door-to-door visits to monitoring the regular and correct use of bed nets, to disseminating key messages on preventive treatments and malaria case management, to collecting data to inform decisions.

The project also regularly conducted community dialogues to share what it was found during home visits and to recommend positive actions that improved health and well-being. Community dialogues helped gather first-hand descriptions from the community members and leaders about their greatest challenges in the fight against malaria. In addition, they helped community members feel they were part of the solution for malaria control and prevention and built trust in the project and the prefectural health officials, which helped increase sustainability and self-reliance.

When COVID-19 hit, the project worked with local governments and local partners to adapt activities to the pandemic context, such as adapting a seasonal malaria prevention campaign that reduced the risk of spreading COVID-19 while still reaching young children with the vital medicine they needed to prevent malaria infection. StopPalu+’s established community relationships were also critical in communicating the importance of seeking timely treatment for fever, especially in the context of COVID-19 when many people were afraid to go to health facilities.

Used Data to Inform Malaria Prevention and Control Interventions

StopPalu+ used information and evidence to gather lessons and continuously adapted activities using a monitoring, evaluation, research, learning, and adapting (MERLA) approach. The MERLA approach used monitoring and evaluation data as more than a reporting requirement; instead, it leveraged programmatic data and added operational research findings to drive planning, decision making, and implementation.

One major challenge was the lack of regular attendance by pregnant women of their health appointments, which are crucial for delivering preventive malaria treatments. The project conducted a study to identify areas with low attendance rates and proposed solutions. StopPalu+ then developed activities that encouraged pregnant women to keep their appointments, such as using SMS appointment reminders and educating female family members who could influence their pregnant daughters and sisters to attend visits.

The project also built the capacity of health providers and leaders in Guinea to leverage data to make informed decisions. StopPalu+ has supported more than 2,000 monthly meetings a year for health centers and health districts to discuss data quality management and ensure it continued to improve, and with the project’s support, Guinea drastically improved the completeness of its malaria data from 30% in 2013 to 100% in 2020. Having this quality data was critical, because it allowed StopPalu+ to partner with district health teams to organize mobile clinics in communities with higher rates of malaria that were hard to reach.

Learn more about RTI’s work in malaria prevention, control and elimination.