Malaria Elimination, Iran, Zahedan

Community Mobilization and Participation in Malaria Elimination in Southeast of I.R. of Iran

Community Health Volunteers (CHVs) are communitymembers who work as a strong link between the healthcare system and people in different layers of community.Each CHV will be assigned to a specific catchment areawhich comprises 40 households. Upon recruitment, theyparticipate in health training classes which take place inboth urban and rural health centers on a weekly basis

Community Mobilization and Participation in Malaria Elimination in Southeast of Iran

The training sessions covers a wide range of health topicsincluding maternal and child health, communicablediseases prevention and control, non-communicablediseases, etc. They convey the health knowledge attained during the training courses to thecommunity members, particularly their relatives and neighbors.They do not expect any financial support for what they dosincerely to improve health condition of the community.

Recruitment of a significant number of qualified andenthusiastic volunteers from the community membershas enabled Zahedan University of Medical Sciences toengage them in a variety of primary health care activitiesand also in implementing health promotion plans in closecollaboration with healthcare workers. They transfer healthmessages to the community in a simple understandableway and in lay person terms using the local languages. More than 10 thousands of CHVs have been recruited by both urban and rural health centers affiliated with Zahedan University of MedicalSciences. The majority of those CHVs are female (70%)and the rest are males.

As malaria becomes more uncommon, utilizing uniquemotivators for communities to seek early diagnosis andtreatment is important, particularly as other healthconditions that cause fevers become increasingly morecommon. The initiative to involve community membersin the provincial malaria elimination programwas launched as a pilot project in Kohak village, in Sravandistrict in 2007. After participating in malaria healthtraining programs, volunteers started regular door-to-door health training based on a two days per weekschedule. In addition to face-to-face health trainings, theywere active in screening and diagnosing the suspectedmalaria cases. During the first year of the activity, volunteerscould detect many new malaria cases and also identifiedlarval habitats. Based on the results from the abovementioned community based intervention the programwas expanded to all districts across the province.

In order to maintain and improve the achievementsin the malaria elimination program and given the fact thatthe main national malaria program strategy has already changed from control to elimination, it was necessary to mobilize allcommunity resources to achieve the elimination goals. Hence, Zahedan University of Medical Sciences Vice Chancellor for Healthproposed an organized community participation plan in order to eliminate malaria in the province. This project has been started fromSeptember 2013 with cooperation of Communicable Disease Control, and PHC Network Development (communityparticipation program) and Health Promotion Departments. The project was approved by Ministry of Health NationalMalaria Program and UNDP, Tehran Office.

The main objective of this project was to improve social awareness with regard to malaria preventionand elimination via community mobilization and participation in malaria elimination activities.

Community Health Volunteers main activities included:
• Training of the population under coverage on malaria prevention
• Screening of suspected cases and referral of detected patients
• Community mobilization and participation in vector control activities such as IRS (Indoor Residual Spraying), LLINs(Long Lasting Insecticide-treated Nets) distribution and larvicidal treatment of vector habitats
• Cooperation in patient treatment and follow up

A special training package (i.e. a flip chart) in lay person terms was developed for community training. The flip chartcomprised of subjects such as malaria routes of transmission, signs, symptoms, diagnosis, treatment and prevention.At the beginningthe CHVs participated in theoretical training sessions in health centers which included information regarding malariaepidemiology, signs & symptoms, routes of transmission, prevention and diagnosis methods. They also attended practicaltraining session on how to prepare peripheral blood smears for malaria microscopy, how to use the RDT kits, how to setup mosquito bed nets (LLINs), and how to implementlarvidices. After completing the training courses andlearning how to complete the designed forms, the CHVswere provided with necessary items including malariaflip charts, RDT kits, slides, etc.

The CHVs were divided into groups of two and eachgroup was given a unique code. The teams were assignedto a specific catchment area and an area map was includedin their activity files. They started the project by door-to-doortraining of the community members an alsoscreening for suspected malaria cases. Potential vectorhabitats were also identified during home visits andnecessary vector control activities were carried out undersupervision of malaria officers. After accomplishing theactivities each household entrance door was marked bythe letter M and the group code.

Detection of the suspected cases by CHVs volunteers wasone of the important achievements in this project.The volunteers also have been working on identificationof larval habitats in the area. One of the most importantefforts was to train population about covering theirwater reservoirs, draining stagnant water and larvicidaltreatment of bodies of water.Other activities of CHVs included training of communitymembers regarding proper set up and use of mosquitobed nets (LLINs) and encouraging people to cover theirdoors and windows with mosquito nets.
During the IRs activities, the CHVs contributed byinforming population and preparing them before thespraying.

Some of the achievements of has been presented in UNDP official website, Tehran office under the title "The honorary work of Community Health Volunteers to eliminate malaria in the Islamic Republic of Iran"

During World Malaria Day ceremonies held by Ministry of Health, Malaria program, Participation of CHVs in Zahedan University of Medical Sciences has been presented as a great example of community involvement in malaria elimination and prevention. For instance, during the World Malaria Day 2015ceremony, Zahedan University Medical Science female health volunteers demonstrated - through role-play - how these knowledge sharing exercises take place in the rural communities. The report of this event has been posted on the UNDP official website, Tehran office under the title "Women volunteers demonstrate malaria awareness projects through role play ".

Since we believe that community participation is major step towardsachieving malaria elimination goals, the project has been expanded to all health centers affiliated with Zahedan University of Medical Sciences and CHVs have shown prominent commitment and contribution to tackling malaria in the province.

Click here to watch the video titled "Heroes in small villages".