George’s motorbike is parked in the shade of a tree in Kindu, a district in the eastern Democratic Republic of Congo (DRC) that spans a stretch of the mighty Congo River. As the diocesan health and development coordinator for the Diocese of Kindu – part of the Province of the Anglican Church of Congo – George depends greatly on his trusty bike to get him to remote communities “beyond the end of the road.” In these rural and hard-to-reach areas, people often have limited access to government health services. As a result, malaria, diarrhea and other easily preventable and treatable illnesses risk becoming fatal, particularly in children under age five.
George swings a leg over his motorbike and starts the engine. Today he is traveling with a group of NetsforLife® Malaria Control Agents (MCAs) to an awareness-raising event at a church in Alunguli, just across the Congo River from Kindu Town. Kindu is the capital of Maniema Province, which is roughly the size of Oregon and is divided into 18 health zones. The DRC’s National Malaria Control Program (PNLP in French) oversees the program as a whole and coordinates with implementing partners such as NetsforLife® and UNICEF. UNICEF is distributing nets using the standard fixed-point method in nine of the health zones, and the other nine are using the NetsforLife® method.
NetsforLife® is Episcopal Relief & Development’s award-winning, flagship malaria prevention program. In addition to distributing millions of mosquito nets to prevent the bites that cause this deadly disease, the program aims to create a “net culture” so that people are aware of the life-saving value of nets and repair or replace them on their own. The long-term impact of malaria prevention knowledge will help to sustain the gains made so far in reducing deaths and illness: in the last decade, the number of lives lost every year has fallen from 1 million to 627,000, but it will take the combined efforts of governments, corporations, communities and faith-based organizations such as Episcopal Relief & Development to finally eradicate the disease.
George leads a coordination committee of five Anglican staff and four United Methodist Committee on Relief (UMCOR) staff to manage house-to-house net distribution and follow-up in the areas where NetsforLife® is active. Each of the committee members is responsible for one health zone, and George’s health zone, Salamabila, is a bumpy 220 miles south of Kindu. But to get to Alunguli, George just loads his bike into a wooden canoe and sets off with the local MCAs.
As the health coordinator for Kindu, George manages all of the field-based staff and liaises with partners and the government around malaria prevention on the provincial level. The overall goal for Maniema Province is to distribute 1.2 million nets through 6,000 trained volunteers, but in order to get the excellent results the program is known for, there is a lot of community education and engagement to do beforehand!
In Alunguli, George and the local MCAs talk with community members gathered at the local church about the causes of malaria and how nets save lives. The MCAs have been doing a huge amount of groundwork in addition to this event, training and working with health zone officials, religious leaders and other community representatives to spread the word about NetsforLife® and the benefits of the direct-hang strategy. They gathered community feedback about having more female MCAs so women would feel comfortable welcoming the team into their homes to hang nets over sleeping areas. They also created a series of entertaining educational radio spots to encourage people to become more open to the program and allow MCAs access to their homes and bedrooms. In a way, the net distribution is really just the tip of the iceberg – beneath the surface there is a huge amount of community support, investment and education in prevention that will help Alunguli stay on track toward eliminating malaria and building a healthier future.
“I was initially worried about the cultural barriers [of entering people’s homes and hanging nets over the sleeping areas], but the effectiveness of the NetsforLife® communication strategy gives me joy,” George says, smiling. “As the team arrives during a visit to the home, they are able to give direct and personal education about prevention and the use of the mosquito net, which ensures better understanding. This is a strength of the hang-up strategy over fixed distribution, where the health center is noisy and it is difficult to transmit a good message of education.”
Demonstrating the impact of NetsforLife®’s unique approach is a key part of encouraging communities like Alunguli to participate, and of advocating with countries to adopt it as national policy. In Maniema Province, NetsforLife® is working with UMCOR, PNLP and UNICEF to further advance a 2012 University of Kinshasa study comparing the innovative house-to-house method for distributing nets with the more standard fixed-point method. The previous study showed that the direct approach resulted in more nets correctly installed in homes, both immediately after the distribution (98.6% versus 88.6%) and five months later (85.5% versus 68.5%), than the fixed-point method.
This means that although the method of hanging nets directly in homes takes more time and funding to implement, the short- and long-term impact of the program is much deeper – a difference that George attributes to the education and engagement work of the local volunteers.
“There is a challenge for Kindu to do well, particularly with the follow-up and accurate data collection, as the Kindu work will have great repercussions on future work in the DRC,” George says. “If positive, it may pave the way for the government to adopt the methodology and thus open the door for the Church and NetsforLife® in other provinces. I am happy that we are able to show all the other collaborators involved in the campaign the benefits of the hang-up strategy. The benefits are clearly visible to all!”
Always thinking of what more could be done to improve life around his diocese, George is already pondering how the MCAs could help tackle other health issues such as clean water, sanitation and hygiene. Indeed, NetsforLife® as a whole is considering how to leverage its networks and teams of trained, caring volunteers to promote maternal and child health, improved nutrition and seeking medical attention when needed. On the government side, the program is advocating to bring health posts closer to remote villages in order to reduce this as a barrier to care.
“Kindu would be a great place to do more,” said Dr. Abebe Aberra, Senior Health Advisor for Episcopal Relief & Development. “The diocesan development office currently manages a range of locally led programs that improve health, economic activity and food supply, and there are many people who, like George, are committed and involved in strengthening their communities. Their work continues to inspire me and I know they are an inspiration to others in the DRC and regionally. It is great to see how NetsforLife® is making an impact in the malaria sphere and beyond.”