Helping to Eliminate Malaria in Botswana
CHAI staffer on the ground tells his story
By JP Nogues
Since January 2008, I have supported Botswana's national malaria control program (NMCP) as it works toward a goal of eliminating local malaria transmission. Achieving elimination is like running the last leg of a long-distance race. It requires a change of pace and an intensification of efforts that may appear daunting to one accustomed to the methods of the past. As a NMCP colleague memorably put it, malaria elimination can be achieved only by "business unusual." A perfect example can be found in how the Clinton HIV/AIDS Initiative (CHAI) is working with Botswana to change its model for the distribution of mosquito nets.
In the past, Botswana has used its health clinics as distribution points for long-lasting, insecticide-treated bed nets. These nets were sold at a greatly subsidized price, or even provided for free to pregnant women and children under 5 years of age. Even so, less than 10 percent of households in malaria-prevalent districts own even one bed net, and a significantly smaller percentage of young children and pregnant women actually sleep under such nets regularly. How, then, could we help Botswana reach the 80 percent coverage target recommended for countries pursuing elimination?
The innovation we hit upon was inspired by Botswana's annual indoor residual spraying campaigns, in which government employees travel from house to house, applying insecticide to the interior walls of homes to repel mosquitoes. The spraying campaign in Botswana has achieved much higher coverage rates than bed nets, averaging between 60 percent and 70 percent of households in targeted areas. The advantages, it seems, are that the spraying campaign intervention is free to all members of the community, and is delivered directly to their homes. What if bed nets were distributed in the same way?
Over the past eight months, I have helped the Botswana NMCP to implement a pilot bed-net distribution project in the malaria-endemic Okavango district: 32,000 bed nets, donated by Malaria No More, were distributed free of charge by the same teams who conduct the annual spraying campaigns. In each village, drama groups put on humorous and interactive "edutainment" presentations in the local languages, focusing on the proper use of bed nets and encouraging communities to welcome the distributors into their homes. The distribution teams then went door to door, assisting the residents in hanging bed nets over each of their sleeping spaces. After distribution, community-based volunteers have conducted follow-up visits to ensure that families are continuing to use the nets they received.
The community response has been overwhelmingly positive. In the town of Gumare, I observed schoolchildren at an "edutainment" event enthusiastically describing why sleeping under bed nets would protect their family from malaria. In the village of Samochima, I watched as an elderly man helped a distributor hang nets over every bed in his homestead. The initial results are impressive, indicating that more than 90 percent of households received nets, almost all of which were hung immediately. I hope that the final results of this pilot will convince Botswana's government and its supporters to expand free, door-to-door, bed-net distribution to the other malaria-prevalent districts of Botswana, and perhaps serve as a model for other countries as well. In doing so, they will take a leap forward toward our goal of malaria elimination.
JP Nogues, a Malaria Program Analyst in Botswana, has been working for the Clinton HIV/AIDS Initiative since January 2008.
