The effectiveness of the Competence Approach in the struggle against Malaria

Our investigation to look for results, with representatives from the National Malaria Control Programme and the Nova Scotia Gambia Association (NSGA), led us to the very spots where the Competence approach and its Self Assessment tool had been introduced during the two previous years. First, in Sohm, south of Banjul, then along the north bank of the Gambia river, in Barra, Essau, Madina Bafuloto, Kerewan, Salikene, Illiasa, Parafenni and Maka Farafenni.

In Sohm, an average of five young children died from malaria every year. “Since we have been helped by the Self Assessment, no child has died,” states Mrs Sera Badjie, the Alkalo’s wife.

She explains that people were linking malaria to witchcraft. It was impossible to discuss this matter due to lack of knowledge and awareness. “Now, our group of women can easily communicate on these matters with the community, discuss the causes of malaria, symptoms and means of prevention and treatment. The Village Development Committee has made by-laws to change behaviour in a way that is hostile to the mosquito.”

M. Lamin Badjie, chair of this Committee, admits that before making its Self Assessment, the community ‘barely knew’ what malaria was. “We are very fortunate that Adama came to us! We have acknowledged the way of transmission of malaria, and how important it is to clean the environment to get rid of the breeding sites of mosquitoes."

Some people in the village could not afford a bednet. But because the Village Development Committee is aware of the importance of sleeping under insecticide treated bednets, they took an initiative to help villagers to acquire them. The Committee first created a credit fund to help them. Then, its members contacted an NGO who provided bednets. “We have not had any severe case of malaria for two years,” concludes Mr Badjie.

In Bara, on the other bank of the river, the Alkalo, Mr Kenbugul Faye is positive. “The struggle against malaria has never been so easy. We will never stop the fight!”

He remembers the numerous miscarriages of the past and the sadness of the families.
“This does not happen any longer because the pregnant women go to the Health Centre for the ante-natal visit." And if the Alkalo admits that some villagers did not use their bednets in the past, he adds that they changed their minds, and their behaviour, when he threatened to take back the bednets!

Farther westward, in Madina Bafuloto, we meet the Head Teacher of the school together with representatives of different village groups. He tells us that he participated 'with enthusiasm', last year, in the Self Assessment process. He quotes a measurable result of the Malaria Competence approach. Every year, the community gets a grant of 1000 US dollars from a German NGO. This money is dedicated to support malaria consultation fees for the Health Centre. Five dollars per visit are given to those 18 years old and more, and one dollar for those under 18. “Two years ago, we used to spend this grant within two months. This year, it lasted six months!”

Mrs Kalsoum Jankou, wife of one of the marabouts, is head of the women’s group. She brings her own figures. Soon after she had done the Self Assessment with eight members of her group, she organised a larger meeting with 200 hundred women from the village. “For the very first time, we had the opportunity to talk about malaria prevention, and to persuade those who did not use insecticide treated bed nets. Then we went from house to house to go on with counseling. And one day 300 of us gathered together to remove from the village all the empty cans and old tires that provide breeding sites for the mosquitoes.”

In Madina Bafuloto, NSGA facilitators also trained Bubacarr Ay Jallow, in charge of the youths, together with eight members of his group, in the use of the Self Assessment tool. Then, they were given the mission to run Self Assessments in eight nearby communities. This was a very rewarding activity according to Bubacarr Ay Jallow. He gives an example. “Two families were permanently fighting. Each of them was convinced that the cases of malaria hitting its members were devils sent by the other family. Today they are reconciled."

In Salikeni, when we arrived at the Basic Cycle School, the 800 pupils were gathered in front of the main building. Once the prayer finished, the Head Master declared with pride, "Even the BBC has announced that malaria has been reduced in our country!” Then, he exhorted the children to take the struggle against malaria seriously, and he handed over to the Peer Educators. This group of 13 girls and 12 boys has been trained by NSGA to provide information to their colleagues about malaria. The youths started singing, “We have been using the Self Assessment tool to roll back malaria...” Then they performed a drama in which we could see a couple, their relatives and neighbours arguing about the case of a sick child. The school children were listening and frequently laughing. They were clearly getting the messages.

The Maths teacher, M. Demba Marana, and his colleague who teaches English, lead this group. “I ask them to tell me what they know about malaria. Starting from that we write the little dramas they will perform, here at school, but also in the nearby villages.”

Each drama carries a particular message: recognise the symptoms, go directly to the Health Centre, attend the ante-natal visits, get rid of stagnant water, use bednets, etc.

“I gave a copy of the Self Assessment framework to each member of the group,” says Mr. Demba Marana. “This is a big help for them to start a conversation about malaria at school or in the communities. This tool really helps us to communicate.”

Once every three months, the group performs in Salikene and in the surrounding villages. “Last time,” reports Mr Demba Marana, “the parents were so proud to see their children bringing these good messages in a perfect English that some of them started singing and dancing!”

The Alkalo of Salikeni greatly appreciates the impact of the drama group. “Before these performances and these public awareness actions, malaria was a terrible nuisance... it created social division within the community. Many people believed that malaria had something to do with witchcraft and that some community members were responsible for it. Using the Self Assessment tool has made us free from such beliefs. When someone shows symptoms of malaria, people no longer go to the marabouts to get rid of the curse. They go to the Health Centre."

“Since the community gathered to clean the environment,” adds the Alkalo, “there has been a massive reduction in malaria cases.” And he states, “I am convinced that we will succeed in eradicating malaria completely. ”

Small children are taught about malaria too. As we arrive in Illiasa, ten boys and girls aged 7 to 10 welcome us singing this song, “Malaria arrived, it is a dangerous illness. Let us throw it out before it invades our community. It is a dangerous illness.”

And they answer our questions without hesitation:

• What brings malaria?
• The mosquitoes. They breed in pools of dirty water. If they bite us, we get sick.
• Where do you sleep?
• In our bed, under a mosquito net.
• What must we do to get rid of the mosquitoes?
• Keep the house and its surroundings clean.

Mr Tamba Jemmey, school teacher in Illiasa and member of the local drama group comments, “These children bring all these messages home. Through them, we reach the parents.”

At the local Health Centre, the nurse, Mrs Bakari Kinteh appreciates all that has been done to make the population aware of malaria. She points out that before the NSGA facilitators came, she would see patients non-stop from 8:00 am to 2:00 pm. “Now, the last patient leaves at 10:00 am. Morbidity and mortality have been dramatically reduced.”