Innovative Interventions to break barriers to access for effective malaria treatment amongst conflict-affected communities in Cameroon
Written by Lundi-Anne Omam
for Reach Out Cameroon and Partners (Malaria Consortium and KASAFRO)
The World Health Organization in 2021 estimated that about 234 million cases of malaria occur in Africa which accounts for 95% of the global malaria cases (1). Cameroon is one of the 11 African countries with the highest burden of malaria; and malaria continues to be a major cause of morbidity and mortality with vulnerable populations, particularly conflict-affected populations at risk (1-3). Conflict exacerbates existing health disparities, making it even more difficult for people to access health services, including malaria prevention and treatment (3).
The conflict in Cameroon's Anglophone regions, which began in 2016, has made worst the malaria situation in those areas. The conflict has disrupted health services and led to displacement, making it difficult for people to access malaria prevention and treatment services. More than 679,000 people have been displaced in the Anglophone regions, with many living in overcrowded settlements (4, 5) where malaria transmission is high.
World Malaria Day is celebrated every year on April 25th to raise awareness and mobilize communities to take action against malaria. This year's theme is "Time to deliver zero malaria: invest, innovate, implement'' with a goal to accelerate efforts towards achieving malaria elimination. In conflict-affected regions of Cameroon, where access to healthcare is limited, Reach Out Cameroon in collaboration with Malaria Consortium and KASAFRO are testing the implementation of three innovations to break barriers and increase access to malaria service demand and supply. This implementation research is carried out in 80 conflict-affected communities of the Southwest and Littoral regions of Cameroon and began in 2020.
One intervention being tested is the Community Health Participatory Approach (CoHPA), which involves regular community dialogues facilitated by trained community health volunteers. So far, 864 CoHPA meetings have been held and led by community members where 17313 (10773 female and 6540 male) community members attended leading to 658 community driven actions being undertaken by the communities to adopt healthy malaria seeking habits within the community. This intervention not only increases awareness but also instils a sense of social accountability towards malaria prevention, ultimately building community ownership over their malaria risk reduction actions.
Another intervention being tested is the Health Voucher System, which allows research participants to purchase specific malaria services at health facilities or with community health workers (CHWs). These vouchers are provided monthly according to the estimated malaria burden in each of the 80 project communities. Working closely with community health workers and health facilities, over 1240 under-five children have been treated for severe malaria and 921 transport vouchers have facilitated the transportation of patients who could not afford transportation cost to health facilities for malaria treatment. More so, to date, 8358 community members have made use of community vouchers to pay for the cost of malaria diagnosis. Through the introduction of this Health Voucher System, the uptake of services for simple and severe malaria by conflict-affected populations are showing an increase in uptake of malaria services in health facilities than reported prior to the introduction of this intervention.
To ensure the quality of these interventions, an advanced model of supportive supervision of CHWs' activities is also being tested. Supportive supervision is an integrated approach that builds good relationships and enhances capacity to deliver quality healthcare. Through our advanced model of supportive supervision, there has been an overall increase by 84% in CHWs competency in malaria case management in their communities.
Interventions like the CoHPA, Health Voucher System, and Supportive Supervision are proving to be critical in breaking barriers and increasing malaria service demand and supply in conflict-affected regions of Cameroon. These interventions are increasing awareness, access to malaria care services, and the quality of malaria case management, ultimately contributing to the goal of achieving malaria elimination. This implementation research is an example of Reach Out Cameroon’s efforts to improve access to malaria services for populations affected by conflict. We recognise the importance of innovating and implementing interventions that will contribute to reach the zero-malaria target.
References
1. World Health Organisation. World Malaria Report. World Health Organisation; 2022.
2. World Health Organisation. World Malaria Report. World Health Organisation,; 2019.
3. Townes DE. Health in Humanitarian Emergencies: Principles and Practice for Public Health and Healthcare Practitioners. Cambridge: Cambridge University Press; 2018.
4. Office for the Coordination of Humanitarian Affairs (OCHA). Cameroon: North-West and South-West Crisis Situation Report No. 10 - As of 31 August 2019 - Cameroon.
5. Office for the Coordination of Humanitarian Affairs (OCHA). Cameroon Humanitarian Needs Overview 20202020 15/10/2020. Available from: https://reliefweb.int/report/cameroon/cameroon-humanitarian-needs-overview-2020-march-2020.
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