Mosquito Nets or Fishing Nets?
How Sanofi innovated patient education to change community behavior and tackle malaria.
Mosquito bed nets were enthusiastically championed by international NGOs as a low-cost strategy to treat malaria, and other diseases, such as dengue fever, that are also carried by mosquito.
But, following high-profile and expensive failures, bed nets programs have been criticized for failing the original vision. Anecdotes shared through the NGO community speak to their misuse; field workers describe their return to points of distribution only to find nets unused, or repurposed for some other activity, like fishing.
There are many theories as to why the nets are not more highly valued. The Guardian cite the uncomfortable experience of sleeping under a net in a hot night, but others point to an underlying lack of understanding of why nets are important to use.
Sanofi, who bring decades of experience working within Tropical Diseases, believe this latter explanation could be absolutely key. If you raise understanding of the severe health consequences that could be easily avoided with bed net use, people will place more value in their nets, and usage will increase.
These educational games empower children to share disease knowledge within their communities. After a high-impact pilot within Togo, Niger, Burkina Faso and Benin, the team was nominated for the Award for ‘Most Valuable Patient Initiative or Service’ at eyeforpharma Barcelona 2016 and went on to win the Award.
Designing and piloting a health awareness program across 4 Sub-Saharan countries, and scaling to 15 countries while working with government, NGOs and local leaders is no small achievement. We were lucky enough to chat to their Vice President of Access to Medicines, Dr Robert Sebbag to learn how his team did it.
Q: Thank you for speaking with us. How did the project get started?
Dr. Sebbag: There are two main reasons. Given our portfolio in Tropical diseases, Malaria has always been a key topic for my department. The second reason comes from a personal perspective. My philosophy has always been that the drug alone is not enough, it is only one part of the solution, so that is why it was necessary to include an ‘Information, education and communication’ team in our department whose sole purpose is to raise awareness of disease information among patients.
If we ask the question, 'why don’t people use the bed nets'? It is because they do not know the risk of the mosquito bite. So it was clear that to tackle this problem, and improve knowledge about how to prevent and treat malaria, we needed to help spread the message.
“My philosophy has always been that the drug alone is not enough, it is only one part of the solution.
Q: A part of the project that stood out to our judges was the design decision to involve children as local champions of knowledge. What gave you this idea?
Dr. Sebbag: I’ve spent many years working in developing countries, and I know how important it is to work with children in the community. They really engage when you deliver an educational message with a nice cartoon, or as a game.
In a previous project we ran in Nigeria, we worked with a local theater company to challenge children to come up with a play to convey a health message. It was really effective. This led our team to approach this problem of bed net use with a similar strategy.
Q: With so many other NGOs, as well as larger organizations like UNICEF also doing health awareness campaigns, did you find yourself having to compete to be heard?
Dr. Sebbag: It is definitely true that when you work in the field you see many, many NGOs working in the same direction. The challenge is to find ways to all work together, if not you will definitely create confusion in the community you are trying to engage.
Partnerships are important for other reasons as well. It is obviously impossible to have someone spreading the word in every village. We have to partner with other NGOs to reach a large area.
It was also really important to try and find traditional leaders and healers within the community, and in fact, if we had a respected local on board we were most effective.
Q: And how did you create these partnerships within Togo, Benin, Burkina Faso and Niger? These aren’t countries where you have country offices. I imagine it must have been very challenging to build trust and find good partners.
Dr. Sebbag: We had a strict protocol that we followed when we went into a country.
Our first contact would be to partner with the National Malaria Control Program, or if one wasn’t present, we would engage the Minister of Health. It was very important to get that green light first in order to have a chance to make a national impact. In order to get the educational game into classrooms, we would also, of course, have to work with teachers. So our next step would be the Ministry of Education to identify teachers who might engage in this program.
At the local level, we would search for an NGO or foundation to partner with. We took advantage of Sanofi’s long history within the region to get started. It was also really important to try and find traditional leaders and healers within the community, and in fact, if we had a respected local on board we were most effective.
We want to reach millions with this program. There are very obvious benefits for other diseases within the same vector, dengue fever and yellow fever are also carried by biting insects.
Q: How long would a typical implementation program take?
Dr. Sebbag: It takes a very long time, even when you have all the contacts. The two main challenges were getting strong engagement with political leaders and finding local partners.
The level of engagement within the government level was very dependent on how much of a priority malaria was to the national health agenda. If they had a national program, it was great, we spoke the same language and they recognized immediately the value we brought by providing educational resources.
Q: What are your goals for the future?
Dr. Sebbag: We want to reach millions with this program. There are very obvious benefits for other diseases within a similar vector; dengue fever and yellow fever are also carried by biting insects.
We have immediate plans to target Portuguese speaking countries within SSA, such as, Mozambique and Angola. But resources are also a constraint. We would be very happy to partner with international NGOs to help spread this approach, as it is very badly needed in many areas.
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