Malaria Prevention and Control (Round 9 Single Stream SSF & SSF Phase II)
In Cambodia, malaria is a health risk for an estimated 2.13 million people who live or work in close proximity to the tropical forests; and malaria remains one of the leading causes of death in Cambodia. Results from a 2007 large-scale survey indicate that mosquito net coverage (people sleeping under a net) was 80% in most high risk areas, but Insecticide-Treated Nets (ITN) coverage remained low (25%) despite re-treatment efforts. Due to poor health care coverage in endemic provinces, especially in remote locations, access to and use of quality malaria diagnosis and recommended treatment remains a challenge. This issue is inappropriately addressed by the informal and unregulated private sector currently used by 60-70% of Cambodian patients with fever cases. The program aimed to strengthen and scale up the most successful control activities.
In Phase 1 (GF-RCC Round 9), PfD conducted community-based interventions focusing on geographical and strategic areas where gaps have been identified and where government or other organizations have difficulty reaching. PfD focused on reaching out to mobile and migrant population (MMPs) by developing a strategy to work with MMPs, private companies, land development companies, owners of plantations and relevant local authorities at all levels including communities. PfD piloted the design and development of a forest package containing prevention, diagnosis and treatment products to be distributed through various channels to mobile and migrant population and local forest goers. In phase 1, PfD implemented programs in Stung Treng, Kratie, Koh Kong and Kampot provinces. In addition, PfD managed one international NGO sub sub-recipient (SSR) (Equal Access, now localized to Media One), and managed four Provincial Health Department (PHD) SSR in the four provinces. In Phase 2 (GF-SSF), PfD expanded these community-based interventions within Kratie and Koh Kong provinces.
Key Activities for GF-RCC/R9 (phase 1) and GF-SSF (phase 2):
- Case management: trained health staff, Village Malaria Workers (VMW), Mobile Malaria Workers (MMW), and Plantation Malaria Workers (PMW) on early diagnosis and treatment (EDAT), focused on MMPs
- Vector control: supported PHD/OD development of a mass distribution plan and mapped MMP; supported net distribution; designed and piloted forest package distribution for forest goers
- Surveillance: Performed Day 3 follow up of malaria cases to combat drug resistance by ensuring proper treatment
- Behavior Change Communication: created radio programming and community based malaria education; trained school teachers on malaria health education
- Trained 182 MMW and PMW on malaria diagnosis, treatment and health education; 888 Village Health Volunteers (VHV) on malaria health education; 441 School Teachers on malaria school health education using Child–To–Child methodology.
- Tested 4,285 patients suspected of malaria and treated 939 patients diagnosed with malaria; reached 121,354 individuals and 17,218 school children with community – based malaria health education;
- Distributed forest packages which could prevent malaria to 389 forest goers who were at risk malaria.
Final result: PfD achieved 91.4% of company/plantation workers who slept under an insecticide-treated net the previous night; 97.73% of school children who disseminated malaria prevention messages to their friends, families and other community members through various activities; and the forest package helped reduced malaria cases by 64% among forest goers.
The Agricultural Development Program exceeded its original objectives and close coordination with both the Provincial governments and Departments of Agriculture ensured successful implementation of the field programs. The four objectives of this program, improving agricultural productivity, enhancing household nutrition, supporting the Provincial Agricultural Extension Service, and improving access to markets, are interlinked and many of the activities completed by PfD spanned across more than one objective.
The first objective of the program was to improve agricultural productivity. PfD undertook a number of activities to accomplish this objective, including the introduction of new plant varieties, planting demo plots for farmer education, working with village veterinary workers and other volunteers to improve pig and poultry rearing, and introducing fish farming to households. Activities undertaken to achieve the second objective, to improve household nutrition, included introducing alternative farming techniques to combat cultivation difficulties during the dry season, incorporating fish farmed by the household into their diet, and the distribution of clay water filters. The third objective, to support provincial departments of agriculture was achieved through engaging associate staff to conduct field activities, conducting study tours to expose field personnel to developments abroad, training and providing support for field operations, and developing extension and training materials designed specifically for ADP activities. For the final objective, to improve access to markets, PfD designed, modified, and tested farm equipment for local manufacturing and commercialization and also collected information on market prices for a wide range of agricultural commodities.
The four focal areas of PfD’s community development work for the Allen Foundation in Stung Treng and subsequently Kratie province were: 1) economic development, particularly supporting rural livelihoods; 2) public health and sanitation; 3) public education and local capacity building, particularly improving community knowledge of health, nutrition, and agricultural practices; and 4) assessing and addressing problems in community infrastructure. A silk weaving training program was added to the project in 2001 with help from Veterans International. The World Food Program contributed rice to rice banks PfD built in Stueng Treng as part of its agricultural development support activities.
The project goal was to facilitate community development and quality of life within the eight communities. More specifically, through working with local structures such as Village Development Committees (VDCs), the project aimed to support community-initiated activities in: (a) economic development; (b) public health and sanitation; (c) public education and local capacity building; and (d) community infrastructure and communications.
The project completed “rice banks” in five villages across Stung Treng and Kratie. The banks have improved food security for poor farming households that are at risk of going in to debt or losing their land during periodic food shortages. Working through PfD, World Food Programme provided the rice stock for the banks to these community-constructed facilities. Members of the bank may then borrow from this stock during seasonal shortages; after harvest, borrowers then repay the bank with rice plus an extra 10% “interest” payment in rice. PfD also convinced local banks to provide credit for fertilizer and other key agricultural inputs.
With additional funding from the Allen Foundation, PfD also completed 100 latrines benefitting 567 community members, and provided sanitation education to families throughout the community.
As a part of the MARKETS II Project, PfD strengthened the capacity of 20 agricultural producer associations in financial, administrative and group dynamics in Nigeria’s Delta, Edo and Rivers states, enabling them to effectively manage donor funds, provide valuable services that will enable recipients to increase their productivity. PfD has been collaborating with the MARKETS program since its inception, especially in the development of the Nigerian Agricultural Enterprise Curriculum (NAEC), which PfD has integrated into many of the business development services trainings it has conducted over the years for agricultural entrepreneurs.
In January 2015, PfD signed an agreement with Chemonics to participate in its USAID-funded MARKETS II project to provide institutional capacity building to selected smallholder agricultural producers and processors in three states in Nigeria. The Organizational Capacity Assessment (OCA) Tool was adapted by PfD and endorsed by the technical staff of MARKETS II Project which was administered to each of the selected groups. The OCA Tool was designed specifically for the selected smallholder agricultural associations to diagnose the strength, weaknesses and opportunities available to and existing within these groups. The OCA Tool was designed to assess capacity of the associations in six key areas/sections – governance, human resource management, financial management, monitoring, evaluation and reporting, sustainability, public relations and partnership.
The first MARKETS activity was a highly successful program that fostered private sector-led agricultural productivity, advanced agriculture and trade policy reform, improved farmers’ access to new agricultural technologies, and strengthened both public and private institutions. MARKETS II extended the MARKETS model to improve the performance of Nigerian poor rural farmers or smallholders, their incomes and nutrition through proven private sector demand driven market interventions. The program focused on smallholder farmers who cultivate between 1 and 5 hectares of land, up to 80% of whom are women.
From November 2011 to July 2016, PfD implemented the USDA-funded Growing Resources for the Enhanced Agricultural Enterprises and Nutrition (GREEN) Project in six southern states in Benin: Atlantique, Littoral, Couffo, Mono, Oueme and Plateau. Through GREEN, PfD provided valuable training to over 7,300 agricultural producers and through increasing the farmers’ net income, benefited 36,000 family members.
The GREEN project worked with Beninese farmers’ associations to train vegetable growers to increase the money they take home from their harvests through better growing techniques, through strategies to decrease spoilage between the field and the market, and through improving their understanding of market-driven production. Centered on tomatoes, peppers, and leafy greens, the trainings GREEN provided focused on improving water and soil resources, appropriate use of pesticides, dry season cultivation, and how to handle vegetables immediately after harvesting. GREEN worked with growers’ associations on marketing and business strategies to help them maximize their earnings potential as a group.
GREEN trained 7,390 agricultural producers in vegetable value chain theory, market assessments, and modern methods to improve agricultural production. As a result of PfD’s work, 97% of participating GREEN farmers now produce in response to what the market wants, and 95% of GREEN farmers have increased their vegetable production by an average of over 160% by increasing the number of cultivation cycles from two to three and four ties per year. GREEN’s final evaluation also showed, farmers increased their net income by over 220% and created over 8,600 seasonal jobs.
In February 2012, PfD has partnered with John Snow Inc. (JSI) to implement the USAID-funded Targeted States High Impact Program (TSHIP) to reduce maternal and infant mortality in northern Nigeria. Together, PfD & JSI achieved this through capacity building exercises designed to:
- Improve community engagement;
- Improve the quality of local health care services; and
- Improve health systems effectiveness.
JSI implements TSHIP in 43 local government areas across Bauchi and Sokoto States. PfD supervised the implementation of TSHIP across three areas in Bauchi State: Bauchi, Toro, and Tafewa Balewa. Nigeria has among the highest rates of maternal and child mortality in the world, and these predominantly rural states in northern Nigeria are among the most severely affected: in Bauchi State, under 5 child mortality remains at 260 deaths per 1,000 children, and the maternal mortality rate remains at a staggering 1,549 deaths per 100,000 births.
Partners for Development has improved community uptake of modern family planning, reproductive health, and MNCH services through a combination of capacity building exercises designed to improve the overall efficacy of local health systems in Bauchi, Toro, and Tafewa Balewa. These interventions, carried out with the consultation and full cooperation of local community leaders, included training-of-trainers activities; health education activities for health practitioners and community members on diverse topics such as children’s nutrition, family planning, prenatal care, and malaria prevention and treatment; and connecting community members to services through improving community-based health volunteers’ knowledge of the services available to families.
PfD surpassed the majority of its targets. In particular, PfD reached:
- 51,207 people through family planning counseling;
- 44,763 pregnant women who are receiving/have received IPT for malaria in prenatal care;
- 31,087 mothers & babies, who were assisted by TSHIP-trained skilled birth attendants.
The success stories PfD has collected from the HALE project illustrate the impact TSHIP’s health education programs have had on community health-seeking behaviors throughout conservative Bauchi and Sokoto States, reducing the number of women who give birth without skilled attendants, and dramatically increasing the number of women who access family planning and antenatal care services.
In partnership with the University of North Carolina, PfD performed a 27-month pilot study in Bauchi State – the Alive & Thriveprogram — aimed at integrating microfinance activities with health initiatives. In Nigeria, fewer than 15% of infants under six months old are exclusively breastfed. By using microfinance meetings as a platform to teach young and expectant mothers the benefits of exclusive breastfeeding – whose benefits greatly increase an infant’s chances of survival – these vital lessons began to catch on. Findings from this study were published in the Journal of Nutrition, describing the benefits of pairing communal programming with educational messaging to produce positive results in new and lactating mothers opting to exclusively breastfeed newborns in their first 6 months of life.
PfD has carried out a microcredit and reproductive health program in four states in Nigeria for the last decade. Building on this experience, from May 2011 through August 2013, PfD and UNC conducted a cluster-randomized controlled trial in Bauchi State to test the effectiveness of a multi-component behavior change strategy to improve breastfeeding practices among microcredit borrowers. The intervention consisted of seven breastfeeding learning sessions held during monthly microcredit meetings, 11 cell phone breastfeeding messages (sent weekly as both text and voice), and songs and dramas about the key messages created by the participants themselves and presented at monthly meetings. The leader of the group was asked to share the weekly behavior change messages with group members, and the group had to create one song or drama per month.
The authors of the study concluded that, over time, the gap between the number of women in the experimental group and the number of women in the control group who were exclusively breastfeeding their babies only widened: as the babies got older, more and more women in the control group switched them on to water and solid foods, while women receiving microcredit and behavior change messages were likely to continue breastfeeding. The researchers concluded that “there were significant differences in exclusive breastfeeding to 3 and 6 months by study arm, and that the difference between the arms widened during this period shows that the intervention was successful at keeping more women in the intervention arm on track when Nigerian women typically introduce other fluids and complementary food to their infants (Flax et al 2014).”
Partners for Development (PfD) began implementing the Provision of Business Development Services (BDS) to micro, small and medium enterprises (MSME) in Kaduna state in July 2008 with a grant of $130,000 for the first year of a three year project. The objective of the project was to enhance local to provide appropriate, effective and cost-effective business development services and support to over 1,000 micro, small, and medium enterprises (MSMEs) in Kaduna state. The small entrepreneurs who took part in PfDs trainings in Kaduna were mainly engaged in poultry farming, grain marketing, dairy processing and petty trading. The business development trainings were facilitated using the Business Skills Development Curriculum for non-agricultural MSMEs and the Nigeria Agricultural Enterprise Curriculum for agriculture related MSMEs. In addition to impacting entrepreneurs in Kaduna through BDS training and microfinance, PfD used this opportunity to strengthen its local MFI partners capacity to provide trainings itself. Since then, the local microfinance lender has become an important local provider of business development knowledge; in turn, the MFI has found that those entrepreneurs who have received BDS training are more likely to pay back their loans on schedule.
In 2011, with a $250,000, 2-year seed grant from USAID, Partners for Development (PfD) implemented its “Providing Rural Communities Equal Care through Commercial Transport” (PROTECT) initiative in Kratie province. PROTECT was funded and implemented as part of USAID’s Saving Lives at Birth partnership to test an innovative approach to overcoming transportation barriers to maternal and newborn services in rural Cambodia.
The PROTECT project aimed to develop a replicable and financially sustainable model to ensure access to ante/postnatal care, and delivery and emergency obstetric care in remote, rural villages of Kratie province, in northeastern Cambodia. With local government guidance and management, PfD tested a model designed to leverage the strong local demand for reliable motor transportation to benefit the area’s pregnant women and new mothers. In addition to ensuring low trip costs, PfD negotiated 24-hour emergency transport service for these women by establishing fixed rates for emergency transport, guaranteeing the availability of transport providers, and creating a revolving village loan fund to provide immediate micro-credit to pay for the emergency travel.
In the 13 month period August 2012 – August 2013, a total of 584 emergency loans were made out of the VLF in the 25 villages. 248 of these (42.5%) were for maternal/newborn care.The remaining 336 loans (57.5%) were for other illnesses or accidents, particularly malaria or diarrheal diseases.
Between September 2011 and September 2013, PfD implemented PROTECT in all villages within two Health Center catchment areas, Prek Prasob and Kanchor, with an estimated combined population of 33,115. The members of each area’s villages are subject to the annual floods that make travel by road arduous and hazardous during monsoon season every year. PfD purchased seven remorque motorbike taxis and two stronger koyun tractor-esque taxis to navigate the steep and muddy hills surrounding Prek Prasob and Kanchor’s villages, and established contracts with the local Commune Councils to ensure their continued functioning in each community.
From 2007 to 2011, with support from USAID and in collaboration with University Research Corporation (URC) and Cambodia’s MOH, PfD designed and implemented activities in: capacity-building; information, education and behavior change communication (IEC/BCC); formative and operational research; malaria case management and vector control in the northwest provinces of Battambang, Pailin, Banteay Meanchey and Oddar Meanchey.
PfD developed various innovative IEC/BCC strategies and materials, including the “taxi drivers” pilot project targeting mobile and migrant populations (MMP), based on PfD’s initial research and assessment of MMP travel tendencies. On this premise, PfD recruited and trained local taxi drivers on malaria prevention and treatment, and gave them IEC materials to distribute to their customers. Over 20,000 migrant workers received health education and IEC materials. Due to the success of the pilot, the Battambang provincial health department adopted it as one of its community-based malaria interventions.
Working in collaboration with the Provincial Education Offices in Kratie and Koh Kong, PfD designed a curriculum for educating children on malaria transmission and prevention for its School Health Education programs. Based on the Child-to-Child Methodology, this program enables school children to become peer educators and disseminate key messages to siblings, parents and the community through games, songs, activities and community theater productions. Over 55,700 children have been trained as peer educators in Malaria Health Education. PfD leveraged its expertise in school health education and child-to-child methodologies to work with the Ministry of Education, Youth and Sports (MoEYS) to develop a standardized national curriculum for malaria education in primary schools. The MoEYS approved the curriculum and integrated it into primary school classrooms. PfD trained 32 trainers from provincial and district education offices on how to work with teachers to disseminate and integrate the curriculum into school programs.
PfD, in partnership with the Pasteur Institute of Cambodia, the Institute of Research for Development and with support from the National Malaria Control Program, designed and conducted the “Malaria, Mobile Population and Migrants in the Context of Drug Resistance in Cambodia” study which shed light on the relationship between population movement, land development, malaria and the issue of drug resistance. As a result of this study, PfD developed a conceptual and operational framework using proxy indicators to define areas of concern for potentially imported malaria; emergence; and spread of drug resistance. By using this framework and geographical information systems (GIS), PfD was able to identify geographical areas of concern and to estimate the number of people in each of the three categories. PfD continues to refine this framework and develop it as an operational tool.
PfD played a critical role in building capacity among health professionals and community health workers. It designed and facilitated training workshops for health center and hospital staff in malaria prevention and health education; diagnosis and treatment, including severe case clinical management; logistics/drugs management; proposal writing and project cycle management, and selected and trained over 1,500 community members as Village Malaria Workers and Village Health Workers. PfD’s innovative interventions and research contributed to the development of strategies to address multi-drug resistant malaria in Cambodia, and the underlying challenge of mobile and migrant populations in this context.