Award: Healthcare Engagement Strategy 2012 ‘Life Changer’
Winner: Swaziland National Malaria Control Programme
“Swaziland is a country that is transitioning from control to elimination of malaria”, Simon Kunene, Manager of the National Malaria Control Programme in Swaziland tells me. And he should know – from his office he can plot the precise location of every confirmed case of malaria and every intervention put in place by health workers on the ground throughout the country. The GIS (Geographic Information System) platform he uses is part of a tracking and monitoring system that uses SMS messaging via mobile phones, GPS navigation, and data from multiple government departments to win the battle against this killer disease.
According to The Global Fund to Fight AIDS, Tuberculosis and Malaria, which has supported and invested into Swaziland’s National Malaria Control Programme, the tide has turned on malaria in the country, and the number of new cases has halved over the past five years.
While hundreds of thousands of people die of malaria every year around the world, Kunene says that today in Swaziland even one death from the disease is unusual. “When one person dies of malaria, it becomes headline news”, he says.
Swaziland’s National Malaria Control Programme has halved new cases over the past five years, according to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Rapid response
The Programme’s success has been in part thanks to the speed of response to new malaria cases, and the technology to enable this. As soon as a new case of malaria is confirmed by a health worker using a rapid test, it is reported via a call to a toll free number to the country’s Epidemic Preparedness and Response Unit. Data on the case and its precise GPS location is recorded and shared by SMS with the Programme Manager and Surveillance teams who visit the site within seven days to determine the nature of the case, such as whether or not the patient had been travelling in the previous weeks.
“Every time there is a case, I receive an SMS”, says Kunene. “We can show on a map where our problem is. Then we can look and see what interventions we have put in the area.”
Despite having only limited resources, health workers on the ground distribute long-lasting mosquito nets, and homes are sprayed against mosquitoes. “We’re very focused”, says Kunene. “In view of the limited resources that are available, we put interventions where we know they will make the greatest impact”.
Kunene attributes the success of the programme to removing the lag in reporting cases. “Swaziland is epidemic-prone, so if you don’t detect your problem early, by the time you realize it, the situation will have got out of hand completely. With this system, we are able to know what is happening and where.”
Mapping the environment
The Programme also analyses malaria cases in the context of environmental variables ranging from mosquito breeding sites to weather and altitude. “Using satellite images we have captured all the breeding sites for mosquitoes. So we look at how far is a [malaria] case from a breeding site”, Kunene tells me, “and we continue to improve our understanding of environmental variables”.
Working with other government departments and external partners, the National Malaria Control Programme is now developing an early warning system that will highlight areas at risk of an epidemic. Swaziland’s National Meteorological Services provide rainfall, temperature, and humidity data; and these are mapped against information about vegetation and land use.
Kunene says that changes in land use can affect the epidemic risk. “If a new irrigation scheme has been started, this introduces water in a previously dry area. Land use is also very important because it also influences the population movement in search of employment opportunities.”
Systemic challenges
Among the challenges faced in implementing the Programme was that of technical integration with multiple government departments. While the National Malaria Control Programme used the latest GIS technology, other departments lagged behind. “But we are influencing the whole public health sector in the country now to show them GIS is the thing to do. So now they are taking it up, like with TB [tuberculosis] cases…we are influencing the whole public health system in the country when it comes to GIS application.”
A new way of working
For public health workers on the ground, who play a vital role in the programme’s implementation, the adoption of the Immediate Notification System represented a new way of working. “With health workers, the uptake of anything new is not always very fast. This was one of our challenges”, says Kunene. But the problems were at all levels of the healthcare delivery system; many doctors, for example, did not trust the new rapid tests which provided results immediately, so they would often continue to treat patients even when tests gave a negative result.
Kunene says that there were two key solutions to these challenges:
- Be very patient.
- Communicate well, providing feedback and encouragement.
“You must demonstrate the benefit of the new approach. Provide regular feedback to the people who provide you with the information – they must realize that they add value to the programme. Once people feel appreciated, that they are contributing to the programme, they will definitely buy in. And give them feedback, so they see it’s working and realize their importance in the whole initiative.”
Clearly Kunene’s patience has paid off. With Swaziland well on its way to malaria elimination, we are pleased to award the Healthcare Engagement Strategy 2012 ‘Life Changer’ Award to Swaziland’s National Malaria Control Programme.
