Background
Methods
Qualitative approach and research paradigm
Context
Sampling strategy
Data collection instruments and technologies
Units of study
Data processing and analysis
Techniques to enhance trustworthiness
Results
Actors | Central (donors, IP, MoH) | Provincial (IP, PHA) | District (DHA, CA, CHW, CS, ST) |
---|---|---|---|
Approach | Individual interviews | Individual interviews | Individual interviews—DHA and CHW FGD—CA, CS and ST |
Target group (number of interviews) | MOH National Malaria Control Programme (1) Implementation partner (3) Donor (1) | Provincial Health Directorate Provincial health staff (2) IP (2) | District health staff: DHA staff—Namacurra (3), Nicoadala (3) CHW—Namacurra (1), Nicoadala (1) Community actors: CS working on SBC activities—Nicoadala (2), Namacurra (2) Primary ST working on SBC—Nicoadala (2), Namacurra (1) |
Responsibilities | Update the SBC strategies and budget allocation per province Coordinate with donors and central IP | Design the provincial work, budget, and implementation plans | Field implementation |
Main result: CS and ST: Organizational and functional aspects | CS and ST have regular meetings with DHA | ||
Main result: CS and ST: Malaria knowledge | Design of the training curriculum | Training and monitoring/supervision | CA have good knowledge about malaria (mode of transmission, signs and symptoms, and where to seek treatment) More information is needed about the importance of IPTp |
Main result: Perceptions about SBC activities and community involvement | SBC intervention is the key to malaria prevention and control | SBC intervention is very important | |
Main result: Perception about coordination and leadership of the SBC malaria intervention | Lack of central level (MOH) commitment to enable them to take on the technical leadership of the action plans Involving communities at the grassroots is challenging SBC activities are not prioritized in terms of budget allocation | Quality of SBC interventions should be a focus area Lack of standard SBC key indicators Communication and coordination are the key for the success of SBC activities (there is a need for more coordination between the donors and all sectors—for example, education—not just the MoH) |
Themes from content analysis
Organizational and functional aspects of community structures and school teachers regarding malaria prevention
“We meet with the health facility once a month and we have to write a summary report after each meeting. We have a work plan, which is divided into groups, so that this group will work this week and another group will work another week. At the meeting, each group brings the difficulties encountered in the area where they worked. The material that was given to us was a blue capulana with illustrations and pamphlets, which we extended and used to explain. We have flipcharts, T-shirts, identification caps, capulanas, pens, and notebooks.”FGD1_CS Nicoadala
“…We have met yes, monthly. Three times per month. We don’t have a schedule. It has been a random process and when there was an opportunity, we met. Well, regarding the coordination with the health facility, it is very positive. At some point on this exchange of information, we get information on how malaria is transmitted and how to prevent it. We have used some leaflets to show some images in the lectures, orally we have also spoken explaining to the children and we have also the facilitator’s manual. We need large posters to make it easy for kids who sit at the back to see.” FGD2_PR Nicoadala
“….. No. We were only trained to reach students and their caregivers. We don’t have any link with the health facility or health staff. As we said, we only use the flipcharts.”FGD3_PR Namacurra
Malaria knowledge of community structures and school teachers
“…..We know that malaria is a disease that kills but also has a cure, we can medicate, or we can prevent by using these mosquito nets. In case you get the disease, you have to go to the health facility immediately to actually detect the disease. Just showing the symptoms (headaches, cold, joint pain, diarrhoea, and vomiting) is not enough because malaria manifests itself in various ways depending on one’s body….”FGD2_PR Nicoadala
“…Malaria is transmitted through the mosquito bite. An infected person transmits the disease to a healthy person. If not treated, malaria can be dangerous and fatal. To avoid malaria, I sleep every night under a mosquito net but not only this, I take care of my house environment (cleaning, eliminating stagnated water, and sometimes I burn some plants to avoid mosquitoes). The signs and symptoms of malaria include cold, vomit, shaking, the body is warm, headache, diarrhoea, and pain at the joints. Malaria has treatment and we need to go to hospital for treatment and there you can find the right medication. It’s important to finish all the medication course they give there.”FGD1_CS Nicoadala
“…it has to do with immunity, because the pregnant woman shares her body with two people, she is a little weak, while the young man is there alone has nothing to join inside and always comes out on top. The old are also a little weak in immunity (…) pregnant women when they have malaria, if in the first months they may have abortion scares.”FGD1_PR Nicoadala
“…in our community, the bed net is the most used to prevent malaria (…) because it is easy to use and protects us from other insects and animals during the night. We don’t like PIDOM (IRS), it is only useful inside our house and we like to sleep outside when it is too warm. Of course, we also use our local methods such as burning plants and using the green leaves of our three to avoid mosquitoes.”FGD1_CS Namacurra
Perceptions of health institutional actors about SBC activities and community involvement
“… Well, the SBC intervention is very important (…), through SBC we can design some strategy in how to engage the community at all levels, so this is a very key area, because this area designs the strategy to engage the community. This coordination between partners (…), community (…), and us from the system, I think the information arrives more easily to the community level.”IDII1_PHA Zambezia
“…I give 5, because the SBC intervention is the key to malaria prevention and control, but the SBC intervention should be with all stakeholders, both among health professionals, partners, and communities for prevention (…)”IDII1_IP Maputo
Perceptions of institutional actors about the coordination and leadership of the SBC malaria interventions
“… I think what we are fighting (…) right now is the question of quality, quality of our actions in terms of SBC strategies that we are planning and implementing, how the information (key messages) are passing and spreading into the community, and not only ready to come up with community talks (…) we have to know if people really understand and have the right attitude, are they meeting what is required or not? (…) So, our big challenge is the quality of our intervention.”IDII1_IP Zambezia
“….there has been good progress on malaria prevention and SBC activities, there is a need to have a commitment from the Ministry of Health (MoH) to enable them to take on the technical leadership of the processes that are taking place right now so that actions are more coordinated, more reality-adjusted and more effective. Involving communities at the grassroots, this is the central challenge. Empower the MoH to be able to assume this technical leadership, ensure coordination and contextualization and ownership of activities by communities.”IDII2_IP Maputo
“…I think that starting from the principle that (…) I keep hitting the same key, I start from the principle of setting clear indicators, no institutional partner will actively engage in an activity that does not directly evaluate itself (…) But all we do so far, when we report to the health provincial directorate (DPS), there is no template to report communication activities, inclusive there is no clear standard indicators at the provincial and district level.”IDII4_IP Zambezia
“….. The SBCC activities aren’t prioritized in terms of budget allocation.”IDII3_IP Maputo
“…Communication and coordination are the key words for the success of the activities. We have to take into account the relation between health professionals, patients, and communities.”IDII1_IP Zambezia