Last Wednesday, PCV and STOMP Regional Malaria Coordinator Niesha rolled out a new malaria prevention program with a community group of 40 mothers at her health center, working alongside her community health worker supervisor.
The community is currently participating in an IRS (Indoor Residual Spraying) program, where each house is sprayed with insecticide, targeting the upper quadrants of walls where mosquitoes rest. Due to this ongoing program, malaria is front and center in the minds of most of Niesha’s neighbors, community members and staff within the village and health center catchment area.
“During this particular Malaria Intervention, I began by explaining how malaria is a [current] problem in Rwanda , which we can see as we implement the use of IRS in our community,” Niesha explains.
Before implementing the program and working with the mothers in the group, Niesha took time to conduct a formative assessment to be aware of the concerns and motivations within the group.
”We talked briefly about why [malaria] was a problem and some concerns people have in the community. The following concerns came up:
1. What if you need more mosquito nets but can’t afford them?
2. Who is more of a priority if there are limited mosquito nets in the household, for example there is only one, but there is multiple children and the parents?
3. How do I fix my mosquito net?”
After talking through these concerns with her CHW supervisor, Niesha and the group started a short malaria pre-test of questions regarding such information as who was most at risk, myths about Malaria, etc.
When they finished discussing these questions, Niesha and her counterparts introduced the main tool of the program: a simple calendar.
This calendar, is designed to be decorative, while also encouraging and motivating families to take malaria prevention seriously—on a daily basis. The calendar is in kinyarwanda and encourages participants to check their nets for holes and repair it weekly, also checking off every day they use their net.
The calendar was received well, and also brought up a lot of questions: ”People had many questions regarding the calendar. Can I write on it? If I find a hole in my mosquito net, what then? Do I mark it on the calendar? And a very good one, what if I only have one net and not everyone is sleeping under it? Do I check the mosquito net icon?”
This program is weekly and focused on follow up as well as formative action plans, as these mothers gather in small groups to discuss malaria prevention and better prevention strategies in their own homes:
”Some of the these questions were easier to answer than others. We ended our first meeting by discussing how over the next month we would incorporate malaria messages in our Wednesday milk distribution sessions. And we would be checking in on them weekly to check their progress.”
But this information about malaria prevention comes as no surprise to this community that has been assisted by Community Health Workers, Health center staff and other partners involved in Behavior Change Communication/malaria prevention work. Part of the problem lies in communicating the value of using a net every night, and helping this information stick for these families who have heard the same malaria prevention message a thousand times.
To tackle this dilemma, Niesha used a kinyarwanda proverb to drive the message home. Proverbs are often a helpful tool in behavior change and are one that STOMP members are becoming increasingly interested in exploring.
”Lastly, we reminded them “Amagara ntaguranywa Amagana”, which means “health before wealth.” We asked that they show their neighbors their new calendars and spread the same message.”
PCV Niesha works in Rwanda’s southern province, and will continue implementing this program in the coming weeks.