Today I will be talking a little bit on why it’s important to engage men for preventing malaria in pregnancy, particularly in the context of Sub-Saharan Africa and in rural areas As we all know both from evidence and from on-the-ground experience, men can control, both positively and negatively, health seeking behaviors of their partners and families, so it’s critical that we engage them in preventing malaria during pregnancy Today, I’m going to be sharing thoughts in the context of our PMI-funded Malaria Communities Program, which is a three-year community-based SBCC program in three rural districts of Zambia in Luapula Province But before we start a quick backround on CMMB we’re a 100 year old faith-based organization that operates health programs in eight countries, and places donated medicines and medical supplies in another 40+ more annually. We work with a variety of partners – faithbased, government and civil society – to bring healthcare to all, and have worked in Zambia for more than 30 years in various capacities. Today’s presentation is going to zero-in on the three ways we recommend you engage men in malaria projects: sell it, incentivize it and make it man-friendly. But first, a little background on this specific program.
This is a community-based three year project that uses social and behavioral change communication to mobilize communities to uptake malaria prevention interventions. Its goals and objectives closely align with PMI in-country goals. By the project’s end, CMMB will have trained health teams in at least 60 wards in the three districts, increasing positive malaria prevention and treatment behavior among thousands of women and children in Zambia. This community-based behavioral change communication (BCC) program works with traditional and community leaders to spread positive and evidenced-based messages on malaria prevention, such as sleeping under a long-lasting insecticide-treated bednet daily. The program also links with participating health facilities, where community members can access commodities for malaria prevention. CMMB trained 416 traditional leaders, health facility workers and community volunteers to implement the program to date, who have held 544 community BCC events reaching nearly 70,000 community members in these three districts. The WHO 3 prong strategy to MIP (IPTp, use of LLINs and treatment) was adopted by Zambia in 2002 Zambia, Luapula Province in particular, experiences stable malaria throughout the year thus women have some acquired immunity resulting in asymptomatic infections, therefore MIP is imperative for overall health of mother and fetus Sulfadoxine Pyremithamine (SP), commonly called Fansidar, is used for IPTp (administered during ANC) MCP objectives 1 and 2 are aiming to reduce malaria morbidity and mortality among pregnant women. The behaviour change communication activities are held at 2 forums: at the health center (ANC and under 5 clinics) and in the community level Both male and female educators and/or drama group members educate members of the audience about malaria prevention and treatment, including IPTp
Engaging clip showing men participating in SBCC sessions
“ Male involvement in MIP” refers to men becoming more involved and supportive of women’s role in prevention of malaria in pregnancy In Zambia, men play a critical role in women's ability to seek health care, as men are heads of family and often control family’s financial resources Furthermore, in Luapula in particular, men misuse the family nets by using them as fishing nets. As heads of family, they have the power to encourage proper utilization of LLINs/ITNs and also prevent misuse (fishing, construction, farming etc) Last bullet point: Fishing is one of the largest economic activities in Luapula province. Anecdotal evidence and several surveys (****will try to find which ones) suggest that using mosquito nets for fishing is one of the most common misuses. Additionally, MCP team has observed uses of ITNs for construction-sifting stones, agricultural activities-protecting seedling etc. MCP is seeking to educate men and women about the importance of proper and consistent net use for children under 5 and pregnant women (and consequences of misuse). MCP aims to educate both men and women about treatment and prevention of malaria, however, the program failed to target men separately from women, leading to programmatic limitations Traditionally males do not attend activities at health centers or play a significant role in health-seeking behavior, because these are viewed as women’s activities The results, while not statistically significant, support the overall trend observed in educational sessions, during Q&A and in communities overall: Men and women have similar level of knowledge about appropriate use of LLINs and ITNs as well as correct timing and type of treatment for malaria However, anecdotal evidence shows, that women have a higher level of knowledge about MIP-potential consequences, importance and methods of prevention
While, Traditional Leaders engage community as a whole, they could also be asked to encourage men specifically Working closely with churches/faith communities in order to hold mini-education sessions re MIP post services, thusly reaching men and women In educational sessions and dramas, emphasize the importance of the man’s involvement in MIP-through addressing men directly in acting portion and Q&A sessions Engage TBAs men think they are important
Malaria in Pregnancy-Strengthening Health Systems to Improve Outcomes for MIP_Melillo_5.2.12
Engaging Men to Prevent Malaria in Pregnancy:Lessons from CMMB’s Luapula Malaria Communities Program Sara Melillo, M.P.H. Deputy Director On Behalf of the CMMB MCP Team
Program Objectives • Reduce malaria-related morbidity and mortality •Target Districts: Kawambwa, Mwense, and Samfya • Objectives: •To increase ownership and use of LLINs among pregnant women and children under 5. •To increase use of Fansidar (SP) among pregnant women for IPTp. •To increase the proportion of children under 5 diagnosed and treated for malaria within 24 hours of onset of symptoms.
The Program in Action https://picasaweb.google.com/arinalekht/MansaFromMansa?authkey=Gv1sRgCIqVzJ6ogpmh-
Men & MIP: The Importance • Role of the male in the home • Access to resources and healthcare • Net use/misuse • Men as Partners
How We Involve Men in MIP • KAP Survey: Before & After • Role Play • Q&A Community and ANC Sessions • ANC Outreach & Promotion
Sell the Benefits • Engage traditional leaders as your salesmen/women • Use the (not-so-bully) pulpit at church • Emphasize man’s involvement at MIP • Sell the “pros” of IPTp, proper LLIN use in pregnancy • Meet men where they are
Make it “Man-Friendly” • Special MIP outreach sessions just for men • Hold after-hours ANC and community sessions • Mini-speed sessions for men • Male-Friendly SBCC techniques
Incentivize • At the ANC level: through preferential services, partners-geared sessions • From traditional leaders rewarding men who exhibit positive behaviors • Brainstorming other incentives?
Conclusions/Questions The CMMB LMCP Core Team Dr. Moses Sinkala, Country Director Dr. John Banda, Project Director Kennedy Njobvu, Community Engagement Officer Clement Mweshi, Finance Officer Arina Lekht, M&E Officer For additional information, feel free to contact: Sara Melillo: firstname.lastname@example.org
Engaging Young Men for MIP https://picasaweb.google.com/arinalekht/MansaFromMansa?authkey=Gv