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The things we do: How a simple text message is the difference between success and failure

Roxanne Bauer's picture

A woman and her child get the anti-malaria drugs distributed in Freetown.Mobile phones are increasingly prevalent throughout the world, and researchers have found that sending text message reminders can help people follow-through with their intentions, significantly increasing the success of development interventions.

“People need to be reminded more often than they need to be instructed.”

These are the wise words of Samuel Johnson, an English author, critic, and lexicographer.  Even though he lived more than 200 years ago, international development interventions are proving him correct today. 
 
Reminders for Malaria
 
It’s widely known that failure to adhere to a full course of antibiotic treatment results in treatment failure can also encourage bacterial resistance to antibiotics, threatening the sustainability of current medications. This is extremely important for malaria, which, according to the World Health Organization, results in 198 million cases each year and around 584,000 deaths.  The burden is particularly heavy in Africa, where around 90% of call malaria deaths occur and in children under 5 years of age who account for 78% of all deaths. Low rates of adherence to artemisinin-based combination therapy (ACT) treatments has led to prevalence of antibiotic-resistant Malaria in many parts of the world, particularly Africa.  One of the biggest and simplest reasons why people fail to complete the full treatment for Malaria is that they forget.

Thinking about stakeholder risk and accountability in pilot experiments

Heather Lanthorn's picture

ACT malaria medicationHeather Lanthorn describes the design of the Affordable Medicines Facility- malaria, a financing mechanism for expanding access to antimalarial medication, as well as some of the questions countries faced as they decided to participate in its pilot, particularly those related to risk and reputation.

I examine, in my never-ending thesis, the political-economy of adopting and implementing a large global health program, the Affordable Medicines Facility – malaria or the “AMFm”. This program was designed at the global level, meaning largely in Washington, DC and Geneva, with tweaking workshops in assorted African capitals. Global actors invited select sub-Saharan African countries to apply to pilot the AMFm for two years before any decision would be made to continue, modify, scale-up, or terminate the program. One key point I make is that implementing stakeholders see pilot experiments with uncertain follow-up plans as risky: they take time and effort to set-up and they often have unclear lines of accountability, presenting risk to personal, organizational, and even national reputations. This can lead to stakeholder resistance to being involved in experimental pilots.

It should be noted from the outset that it was not fully clear what role the evidence from the pilot would play in the board’s decision or how the evidence would be interpreted. As I highlight below, this lack of clarity helped to foster feelings of risk as well as a resistance among some of the national-level stakeholders about participating in the pilot. Several critics have noted that the scale and scope and requisite new systems and relationships involved in the AMFm disqualify it from being considered a ‘pilot,’ though I use that term for continuity with most other AMFm-related writing.
 
In my research, my focus is on the national and sub-national processes of deciding to participate in the initial pilot (‘phase I’) stage, focusing specifically on Ghana. Besides being notable for the project scale and resources mobilized, one thing that stood out about this project is that there was a reasonable amount of resistance to piloting this program among stakeholders in several of the invited countries. I have been lucky and grateful that a set of key informants in Ghana, as well as my committee and other reviewers, have been willing to converse openly with me over several years as I have tried to untangle the reasons behind the support and resistance and to try to get the story ‘right’.

How Can Complexity and Systems Thinking End Malaria?

Duncan Green's picture

This is complexity week on the blog, pegged to the launch of Ben Ramalingam’s big new book ‘Aid on the Edge of Chaos’ at the ODI on Wednesday (I get to be a discussant – maximum airtime for least preparation. Result.)

So let’s start with a taster from the book that works nicely as a riposte to all those people who say (sometimes with justification, I admit) that banging on about complexity is just a lot of intellectual self-indulgence (sometimes they’re not so polite). We know what works, why complicate things? Hmmm, read on:

‘Kenya’s Mwea region is especially prone to malaria because it is an important rice-growing region, and large paddies provide an ideal breeding ground and habitat for mosquitoes. The application of insecticides and anti-malarial drugs has been widespread, but there has been a marked rise in resistance among both mosquitoes and the parasites themselves.

A multidisciplinary team developed and launched an eco-health project, employing and training community members as local researchers, whose first task was to conduct interviews across four villages in the region, to give a first view of the malaria ‘system’ from the perspective of those most affected by it.

The factors involved were almost dizzyingly large in number—from history, to social background, to political conflicts. A subsequent evaluation of the programme referred to this as an admirable feat of analysis.

Using a systems analysis approach that placed malaria in the wider ecological context was a critical part of the programme design:

Weekly Wire: the Global Forum

Kalliope Kokolis's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

SciDev
Cell Phones can speed up malaria treatment in remote areas

“Mobile phones along with local knowledge and field support, can help to ensure the effective diagnosis and treatment of malaria in remote rural areas, according to a study in Bangladesh.

Researchers examined almost 1,000 phone calls to report suspected cases of malaria that were made over two years by inhabitants of a hilly and forested part of the country bordering Mynamar. This area, called the Chittagong Hill Tracts, has Bangladesh’s highest malaria rates.”  READ MORE

Weekly Wire: the Global Forum

Kalliope Kokolis's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

CIPE
Closing the Implementation Gap

“In every country, sound laws are a key foundation of democratic governance and economic development. Crafting such laws, however, is only part of the path to success. The other half is making sure that the laws are properly implemented – which is often more challenging.

When laws and regulations are not properly adopted, such discrepancy creates an implementation gap – the difference between laws on the books and how they function in practice. This gap can have very negative consequences for democratic governance and the economic prospects of countries and communities. When laws are not properly implemented, that undermines the credibility of government officials, fuels corruption, and presents serious challenges for business, which in turn hampers economic growth.”  READ MORE

weDevelop: Can We Create an Empowering Web of Development with the Individual at the Center?

Tanya Gupta's picture

Development organizations operate at the global level, partnering both with countries to implement country strategies, and within sectors to tackle sectoral challenges.  NGOs on the other hand, operate at the grassroots level, working with individuals towards the betterment of communities.  Development organizations have the advantage of resources, many years of experience and knowledge but are generally several degrees removed from the individual.  NGOs are in touch with the needs of citizens and are able to respond quickly to challenges but unable to scale up.  The two have worked together, but so much more can be done.  Over the last several years the dynamic has undergone a fundamental change.  Cue to technology, which is fast emerging as a game changer in the world of development.  Technology enables linkages based on mutual agreement (e.g. development institutions-NGOs) as well as linkages that evolve organically (e.g. a grassroots human rights group in Kenya that builds a relationship with a Swedish development institution focused on social inclusion).