Strengthening a community-focused response to malaria in Guinea

U.S. Agency for International Development (USAID)
American Society for Microbiology (ASM), Jhpiego, Centre Africain de Formation pour le Développement (CENAFOD)

The global fight against malaria has made dramatic progress. Between 2010 and 2015, the World Health Organization reported that malaria cases fell by about 30 percent both globally and in sub-Saharan Africa. These gains were driven by the rapid scale-up of malaria prevention and control interventions, led by countries’ national malaria control programs and supported by initiatives such as the U.S. Agency for International Development (USAID)-led U.S. President’s Malaria Initiative (PMI).

Despite tremendous advances, the vast majority of malaria cases and deaths continue to occur in Africa. In Guinea, a French-speaking coastal country in West Africa, malaria—paludisme in French—is the leading cause of health consultations, hospitalizations, and deaths.

“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. Through StopPalu, RTI supports 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 boosts local capacity to implement prevention programs that are proven to stop malaria transmission. The project also works to improve diagnosis and treatment for those who do become infected and ill.

Our experts also deliver ongoing technical assistance and training to enhance the government’s ability to plan, manage, and coordinate a comprehensive malaria control program.

A Community-Driven Approach to Fighting Malaria

Under StopPalu, we helped train more than 1,300 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 bednet campaigns, but also assisted in hanging the nets and checked in 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. 

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. Home visits by community health workers dropped, both because residents refused home visits and because fewer community health workers were willing to conduct home visits. 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 Guinea’s National Malaria Control Program in adapting to this difficult and complex context. For instance, 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. After the revision, the project trained 1,041 health facility workers on the new protocols and continued to provide supportive supervision to ensure the quality of case management and to motivate health workers.

We also conducted monthly monitoring meetings at facility and district levels to ensure data on malaria services were collected and reported. As a result of this perseverance, 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.

An upcoming national malaria indicator survey will show just how far Guinea has come in the fight against malaria, as well as show the work that remains to eliminate this deadly disease.