Vital endeavour of malaria control programme implementing activities requires first hand inventory of the community. In the existing health care delivery system, local stakeholders have not been adequately recognized [
Human resources at the community level often become serious bottleneck, which seriously interfere with the programme implementation and malaria programme is no exception. It would not be out of context to stress on the need for capacity building of the community is kept as priority when such national programme is being implemented. Though the emphasis continued to be on training and information flow to the programme implementation, reliable documented data on the available human resources both in the community and the trainers themselves are lacking [
Apart from educating the community regarding malaria, there is a growing need to understand health seeking behaviour of the community [
It is needless to say that there is consensus about the need for RBM implementation. Concurrently, there is need for regular monitoring and evaluation of interventions under RBM. Since high-risk populations vulnerable to malaria are poor, there is a need to device propoor health system.
The key challenge before the health provider is to start working as a part of the health sector team with effective linkages with the like-minded departments/stakeholders [
Indicators to understand the constrains at the field level, which are essential for the community partnerships and maintenance of continued interest in the issue, have to be identified and prioritized for the effective implementation of the programme [
Two studies were carried out; first in four villages of PHU Banavaralu in Tiptur Taluka in September 2002 and the second one in April 2003 in four villages in Chitradurga district namely Kappagere, Kellodu in Hosadurga Taluka, and Vani Vilas Puram and Kathrikenhally in Hiriyur Taluka.
This study was essentially an exploratory research carried out by a multidisciplinary team of researchers with background in epidemiology, sociology, and community development adopting qualitative methods of data collection to gain insights in to the community perspective and the provider perspective.
The community perspective was ascertained through a rapid social assessment of malaria-affected communities and application of standard qualitative techniques, namely, transect walk through villages, focused group discussion and in-depth interview. The
Gender discrimination is coming out strongly in all the villages against women in various walks of life. This applies from her childhood throughout women’s life. Responding community amplified the discrimination—when they admitted differences were present right from admission of a girl child to school. Differences in agricultural wages were also another factor which undermined the position of women in the rural society. However, it should be noted that male members admitted that the contribution made by a women was at par with theirs. This economic disparity got reflected in the decision-making process of the family. The male decisions were predominantly accepted. This discrimination would reflect in health-related activities at family and community level.
In spite of women being elected to represent the community in
Subtle caste discrimination was also observed in study villages that could be barrier in effective implementation of malaria control programme for which total community participation is vital. Community knowledge on
Government policies have added to division in the community by giving more priority to underprivileged communities. Even in the distribution of below poverty line (BPL) card and various other development interventions instances were quoted where the noneligible families had benefited.
Major occupation in the study area was agriculture and sericulture. Majority were BPL families having small pieces of dry tract of land. Treatment for illness for self and the family was unaffordable, due to high costs seeking treatment with private practitioners. The respondents agreed that the government hospitals (PHC) did provide medical services but they did not get satisfactory service from them, hence, they sought services of local general medical practitioners. As a result of high costs for medical treatment, many of the families are indebted to local moneylenders. Malaria has shattered economy of families in the villages. Every house has experienced malaria in the recent outbreak. People have incurred debts due to malaria. On an average, the treatment cost was in the range of 1500 to 12000 on malaria illness.
Due to drought and lack of other alternatives, families migrate in search of jobs outside their own village. There is a shift in agricultural practices from traditional crops to mulberry cultivation which is the main feed for silk worms. Since sericulture is an income generating semidomestic activity, the local farmers refuse to insecticide spray for toxic effects on the silk worms.
The recent programmes initiated by the government seem to have not captured the imagination of the community in the field area. It was observed that the
By decentralizing administrative powers through
Community knowledge on
Concept of health committees is not known. Although health committee as one of the important statutory committees under every Panchayat is mandatory, according to Karnataka Panchayat Raj Act 1993, this is not existent in reality in these villages. This has led to lack of interdepartmental support to various health and development programmes at the village level. This has made public health a low priority for
Financial difficulties at
It was observed that there were generally no specific cultural practices in relation to malaria cure. Cultural and traditional practices in Malaria-related issues were not predominant in the community except for some sporadic instances.
Local temple is visited to know whether the illness they are suffering needs to be attended at hospital or will it resolve by itself. This plays very important role as their treatment-seeking behaviour is influenced by this practice as people have profound belief in this activity.
SPEC study should be considered as an important indicator of malaria control programme. It is ultimately the community that takes the major decision directly of indirectly and the health authority responsibility is to guide them in right direction.
This work is funded by WHO, RBM (India) and partially by the Indian Council of Medical Research, New Delhi, India.
The authors declare that they have no conflict of interests.
The authors are grateful to Dr. Ravi Narayan of Community Health Cell (CHC), Bangalore for helping them in concept development. They acknowledge the contributions of Dr. Paresh, Mr. Prahlad, Mr. Chander, and all team members of CHC in executing the study successfuly.