Simple messages about how malaria is transmitted are yet to reach some communities. Tim Smedley explores how bottom-up initiatives are increasing the impact of donor dollars
A recent US audit of malaria prevention in Benin (pdf) aptly summarises the shortfalls of a commodities-driven approach: "USAid had delivered 705,000 nets -- worth $4.1m -- to 800 health centres across the country, where they had been sitting in storage for nearly eight months ... At [one health centre] the director said she did not understand why the mission continued to deliver bed nets if she and her staff could not distribute them to beneficiaries."
Such top-down approaches are fast being replaced by bottom-up, community-driven initiatives. Becky Weir, senior child health programmes adviser at World Vision agrees. "NGOs are trying to do a lot more in terms of behaviour change within communities. You can't just hand out nets and hope that it will all be OK ... I have seen areas myself that have supposed to have had mass-distribution of nets, but you visit households and they are not in use. Most of the time that is because there has been limited communication about the real value of them."
Stories circulate of bed nets being used as fishing nets, even wedding dresses. Such uses are entirely understandable if distribution is not backed by education and awareness campaigns; or worse, as in the Benin, community distribution systems have not been set-up.
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