Malaria control policies and strategies in Ghana: the level of community participation in the intersectoral collaboration

Abstract

For more than a century now, malaria has been a major public health problem in Ghana which consequently has been one of the country’s sources of underdevelopment due to economic losses, high rate of morbidity and mortality. Faced with this problem, the last ten years has seen a commitment from the Ghanaian government to address the issue by establishing a policy that would transform the way the disease is prevented and controlled. The transformation of the management of the disease by the use of intersectoral collaboration strategy (ISC) was to ensure the inclusion of the grass root community members who were hitherto excluded from participating in policymaking process of the national malaria control programme (NMCP) activities. The idea was that by allowing the communities to participate, members would be empowered to have ownership of programme activities, could accept the challenges associated with the control of the disease, and above all contribute more effectively to the success of the policy goal of minimising the persistence of malaria in Ghana.

However, over ten years now, no systematic study has been done to access the extent to which this policy goal has been rhetoric or a reality. This thesis therefore seeks to examine this vision by investigating the extent to which the community members are allowed by the health authorities to participate in this policy strategy. Drawing on the case studies in the rural and urban districts in Ghana, the practical reality of the degree of community participation in ISC has been explored. In addition, the roles played by the community members in malaria control programme activities were examined with the aim of understanding the importance of communities in malaria control efforts. Finally, the barriers to participation as well as the extent of the institutional involvement in ISC and its possibility to facilitate community participation have also been examined.

Overall, the evidence from the study findings demonstrated that the established strategy of ISC has not significantly promoted community participation in the NMCP activities. While the communities were consulted on malaria issues, they were often excluded from the final decision-making on issues that needed to be acted upon. Consequently, the communities have no guarantee that their views will be considered during the final deliberation in which they have little or no part to play. In spite of this, the study found that through various ways, the community members had been playing a number of significant roles in the control activities. These roles included: supporting health staff in their outreach services, contributing in managing the environment, providing assistance in the monitoring and evaluation of malaria programmes and finally assisting victims to cope with the disease. The findings also indicated that without a number of barriers, certain existing contextual factors (e.g. good level of horizontal integration and political structures and social-cultural institutions) potentially could have contributed to the community participation. From the views of health officials, these barriers were the powers of central bureaucratic structures and lack of resources whilst the community members perceived poverty, lack of support from the local health authorities, the precarious nature of their livelihood and traditional culture as those factors that have undermined participation. These barriers were structural and as such tackling any one barrier in isolation was not likely to solve the malaria problem. Besides, no one government sector, on its own, through participation, could make it possible for the community members to have a full ownership of the control programme activities as well as develop a culture of malaria prevention and control.

Thus in the context of the study sites, the study concluded that although there is no evidence to suggest that ISC has enhanced full community participation, the strategy should be commended. In reality, the finding indicated that through ISC strategy many sectors including the community have become more aware of malaria problem and communicate more to solve the problem together. In the light of this, the study finds joint action in the form of ISC across many government sectors as a potential solution if these barriers are to be dealt with in a more strategic way rather than a piecemeal manner.

In conclusion, it has been argued that with such a complex problem like malaria, ISC with community participation in policy making process is both a necessary and sufficient condition in reducing malaria persistence in the study sites. The health sector must work collaboratively with other related sectors and it is with such collaborative efforts that can change the attitudes of the community members. Changes in behavioural attitudes are paramount if communities’ activities that affect the environment and promote breeding of mosquitoes are to be minimised. Thus with ISC strategy, what is further needed are: proper control planning that will ensure better coordination amongst sectors, adequate resources and behavioural change by the community members themselves. Each of these factors, I believe should not work in isolation, rather must work together otherwise malaria persistence in Ghana will not go away anytime soon.

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ORCID for Nyovani Madise: orcid.org/0000-0002-2813-5295

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