Community Health Volunteers on the Frontline of Malaria Prevention

Madagascar experienced a surge in malaria cases in 2015, particularly in the southwestern regions, despite the Ministry of Public Health’s efforts to combat the disease. Interventions such as insecticide-treated bednet distributions and indoor spraying proved insufficient to deal with malaria in rural areas.

As a result, the Government of Madagascar decided to boost community involvement in prevention efforts. Simultaneously, the National Community Health Policy of Madagascar was updated to focus on institutionalizing CHVs as the foundation of the country’s health program, including its fight against malaria.

Fanamamy Retsilaky is among the most active CHVs involved in this effort. He lives in Amboboka in southwest Tulear II District and benefited from malaria training and follow-up courses provided by the USAID Mikolo Project in the integrated management of childhood illnesses between 2014 and 2016. He regularly sees children with fevers at his health hut where he conducts malaria rapid diagnostic tests. Between 2014 and 2017, Retsilaky tested over 2,100 fever cases, with 1,672 confirmed cases of simple malaria, which were treated with artemisinin combination therapy (ACT). Between January and March 2017 alone, 52 out of 62 children he tested were positive for malaria and were treated with ACT.

CHVs like Retsilaky play a crucial role in the fight against malaria. Many villages are surrounded by rice fields and become almost inaccessible during the rainy season from November to April.

“I often have stock-outs of ACT and have to get to the health center (over 15 km away) to get more,” said Retsilaky. “Parents usually go to the traditional healer first. A sick child from another village was brought to me, although I sent him directly to the health center he died because the parents had used traditional medicine at first and waited too long to come to me.”

Retsilaky works hard to raise awareness in his community about the importance of prompt treatment when symptoms present, along with personal protection, such as consistent and proper use of bednets.

“People in my village trust me because of my dedication to our community, whether seen through my educational sessions or by word of mouth from those I have treated,” he said.

His work has been bolstered by technical training and advice from USAID Mikolo. The project and the Ministry of Public Health’s malaria control department continue to work together to strengthen epidemiological surveillance at the community level as well as enforce seasonal prevention and treatment campaigns in malaria-endemic areas.