On 25 April 2023, Uganda joined the world to commemorate the World Malaria Day. This day was instituted in 2007 by the World Health Organization (WHO) member states with the aim of raising awareness about malaria, and garnering support from all partners and other stakeholders to fight the disease. The theme for this year was “Time to deliver zero malaria: invest, innovate, implement”.
In the run up to this day, Uganda held several activities including the first ever Walk against Malaria spearheaded by the Uganda Parliamentary Forum for Malaria; a ride against malaria in one of its cities; and various awareness campaigns held in several districts. After the malaria week, the hype starts to wane, as the real fight continues. Those who have not been taking malaria seriously now see its gravity and potential for disruption at both individual and societal level, taking lives and disrupting economic gains.
What is next? The inclination now is to get back to the routine of malaria control as we know it using the WHO recommended tools and the approaches that have worked for years, evidence of their effectiveness being widely available. All of us need to take a step back and reflect before engaging the gear again. Let’s ask these critical questions: Why have we not made the dent we have intended with our previous efforts? What is believed to be working BUT seems not to be in terms of approaches, interventions, engagement, tools, etc? Why is it not working? Has it been deployed in the right way, right scale, right place, right time? How do we move on from here?
As an expert in Surveillance, Monitoring, and Evaluation, am still pondering on these questions; I am convinced that we need to take malaria surveillance beyond health facilities and onto the next level i.e Community. Up till now, Health facility surveillance data has played its part in malaria control, but it is time to complement it with a unique understanding and knowledge that may only be obtained from community surveillance. For example, who are the people dying of malaria from within the community; why are they dying from the community; what are the major issues predisposing them to death from malaria, a disease that is both curable and preventable; and what community and household-based interventions can be done to mitigate this?
Granted, community surveillance is not easy, it requires relatively huge investments (human resources, technology, funds, etc), but this is the time to act. There are pockets of innovations coming up, for example, the electronic community health system in Buikwe District, among others. This is a community surveillance platform which we could start with. With this system, community health workers (CHW) are provided a smart phone that guides them through patient registration, assists with diagnosis and advises on treatment and referrals, and a tablet-based app that allows supervisors to monitor CHW performance and stock levels. This initiative provides opportunities for improved work processes and empowers CHWs to report community data in real time, that would previously be reported after 3 months.