Roll Back Malaria Project
Funded by: Global Fund HIV Project in Nigeria
Principal Recipient: Society for Family Health (SFH)
Sub-Recipient: Economic and Social Empowerment of Rural Communities (ESERC)
Project Duration: March 2010 – February 2011
Geographical Coverage: Enugu East, Enugu North, and Enugu South Local Government Areas, Enugu State, Nigeria
Project Background and Context
Malaria remains one of the leading public health challenges in Nigeria, contributing significantly to morbidity and mortality, particularly among children under five and pregnant women. At the time of this intervention, Nigeria accounted for a substantial proportion of global malaria cases, with Enugu State experiencing persistent transmission due to environmental factors, limited access to diagnostic services, poor health-seeking behavior, and widespread presumptive treatment practices.
A major challenge identified in malaria control efforts was the low rate of malaria testing prior to treatment. Many community members routinely treated fever symptoms as malaria without laboratory confirmation, leading to misdiagnosis, inappropriate drug use, delayed treatment of other illnesses, increased drug resistance, and unnecessary financial burden on households. Additionally, awareness about the correct use of Artemisinin-based Combination Therapy (ACT), the recommended first-line treatment for uncomplicated malaria, remained low at the community level.
In response to these gaps, the Roll Back Malaria Project was implemented to strengthen malaria diagnosis, improve treatment-seeking behavior, and promote community-level awareness on malaria prevention and control. The project aligned with national malaria control strategies and global Roll Back Malaria objectives, emphasizing early diagnosis, prompt treatment, and community engagement as key pillars for reducing malaria burden.
ESERC’s Role and Implementation Strategy
As a Sub-Recipient to the Society for Family Health (SFH) under the Global Fund HIV Project in Nigeria, ESERC was responsible for community-level implementation of malaria interventions across selected LGAs in Enugu State. ESERC adopted a community-centered and outreach-driven approach, ensuring that malaria services were brought closer to the people, especially those with limited access to health facilities.
The implementation strategy focused on:
• Bringing Rapid Diagnostic Testing (RDT) for malaria directly to community doorsteps.
• Strengthening referral linkages between communities and health facilities.
• Promoting behavior change through intensive community sensitization.
• Improving knowledge and acceptance of evidence-based malaria treatment protocols.
ESERC worked closely with community leaders, health workers, and local stakeholders to ensure acceptance, participation, and sustainability of project activities.
Project Goal and Objectives
Overall Goal
To contribute to the reduction of malaria morbidity in Enugu State by increasing access to malaria diagnosis, promoting appropriate treatment, and improving community knowledge and practices related to malaria prevention and control.
Specific Objectives
• To increase the proportion of community members who undergo malaria testing before treatment.
• To promote the use of ACT drugs as the correct treatment for malaria.
• To improve early identification and referral of malaria-positive cases to health facilities.
• To increase community awareness on environmental sanitation and malaria prevention.
• To strengthen linkages between communities and public health facilities.
Key Interventions and Activities
1. Rapid Diagnostic Testing (RDT) for Malaria
ESERC conducted community-based Rapid Diagnostic Tests (RDTs) for malaria across Enugu East, Enugu North, and Enugu South LGAs. Testing was carried out in homes, community gathering points, and outreach locations, ensuring access for individuals who might not otherwise visit health facilities.
Community members presenting with fever or malaria-like symptoms were tested on the spot. This approach significantly reduced delays in diagnosis and eliminated the cost and logistical barriers associated with facility-based testing.
2. Referral and Linkage to Treatment
Individuals who tested positive (reactive) for malaria were referred to designated health facilities for appropriate treatment. ESERC ensured that referrals were properly documented and that clients were linked to facilities where ACT drugs were available.
This referral system helped strengthen trust in the health system and encouraged continued utilization of formal health services.
3. Community Sensitization and Health Education
ESERC carried out extensive community sensitization campaigns to address harmful practices and misconceptions surrounding malaria. Key messages focused on:
• The importance of testing before treating malaria.
• Dangers of presumptive treatment and self-medication.
• Correct identification and use of ACT drugs.
• Environmental sanitation practices to reduce mosquito breeding.
• Early care-seeking behavior for fever and malaria symptoms.
Sensitization activities were delivered through community meetings, interpersonal communication, and engagement with traditional and opinion leaders.
4. Promotion of Environmental Hygiene
Recognizing the link between poor sanitation and malaria transmission, the project emphasized environmental cleanliness. Community members were educated on clearing stagnant water, proper waste disposal, and maintaining clean surroundings to reduce mosquito breeding sites.
Key Outputs and Results
• Malaria testing services were brought directly to the doorsteps of community members across three LGAs.
• A large number of community members who would otherwise not have tested for malaria received RDTs.
• Many individuals tested positive for malaria and were successfully referred for treatment.
• Increased awareness of ACT drugs as the recommended treatment for malaria.
• Improved community understanding of the importance of testing before treatment.
• Strengthened trust between communities and public health facilities.
Outcomes and Impact
The project contributed to a positive shift in health-seeking behavior, with more community members recognizing the importance of malaria diagnosis before treatment. By reducing reliance on presumptive treatment, the project helped:
• Improve the accuracy of malaria case management.
• Reduce inappropriate use of anti-malarial drugs.
• Promote early and effective treatment of confirmed cases.
• Strengthen malaria surveillance and reporting through referrals.
The intervention also demonstrated that community-based testing is an effective strategy for increasing coverage and reaching underserved populations.
Challenges Encountered
Despite its successes, the project faced several challenges:
• Limited project duration constrained the scale and sustainability of activities.
• Inadequate availability of health commodities in some facilities occasionally affected referrals.
• Deep-rooted beliefs in self-medication and traditional treatment practices required sustained engagement.
• High demand for testing occasionally stretched available resources.
Lessons Learned
• Community-based malaria testing significantly increases uptake of diagnostic services.
• Bringing services closer to people improves equity and access.
• Health education is most effective when delivered in culturally appropriate and participatory ways.
• Strong referral systems are critical for translating diagnosis into effective treatment.
• Continuous sensitization is required to change long-standing health behaviors.
Sustainability and Way Forward
The Roll Back Malaria Project laid a strong foundation for integrating community-based malaria testing into routine primary health care services. The knowledge gained by community members and the strengthened linkages with health facilities continued to influence malaria prevention and treatment practices beyond the project period.
Future interventions can build on this model by:
• Scaling up community RDT services.
• Strengthening supply chains for ACT drugs.
• Integrating malaria services with other community health programmes.
• Supporting community health workers to sustain malaria prevention efforts.
Conclusion
The Roll Back Malaria Project implemented by ESERC in partnership with SFH and the Global Fund demonstrated the effectiveness of community-driven approaches in malaria control. By taking malaria testing to the doorsteps of residents in Enugu State and promoting evidence-based treatment practices, the project addressed critical gaps in malaria diagnosis and treatment. The intervention contributed meaningfully to improved malaria awareness, better health-seeking behavior, and strengthened community-health facility linkages, providing valuable lessons for future malaria and public health interventions.
