The challenge More than 40% of people in West and East Timor are infected with the malaria parasite. A lack of awareness and knowledge as well as poor environmental health contribute to an increased risk of malaria and have led to epidemics of the disease. Malaria is a major cause of malnutrition, high infant and maternal mortality, low labour productivity and chronic poverty.
West Timor is one of the least developed provinces in Indonesia. With few natural resources it has the highest prevalence of malaria and tuberculosis in Indonesia, as well as high chronic malnutrition rates (60%).
In East Timor, a UNICEF survey conducted in 2002 showed that only 22% of children in rural areas sleep under mosquito nets and only 2.4% of the nets are treated with insecticide.
Past interventions to prevent and treat malaria have proven to be insufficient and malaria rates are rising. District and village health services are poorly staffed and have limited financial resources. Many people are still reliant on traditional healers and other informal health providers. Media campaigns often do not reach communities effectively, due to illiteracy and a lack of access to radio and television.
The governments of Indonesia and East Timor are committed to controlling malaria by 2015 as one of the Millennium Development Goals. New and more effective approaches to prevention and treatment will be needed if the goal is to be reached.
CARE’s response
The MIAT project is an integrated community-based response that targets vulnerable groups, particularly pregnant women and under-five year old children.
The project has four main components:
Screening of malaria cases and supporting the use of information management systems
Village Malaria Posts are critical front-line services to identify and treat those with fever in a community. Volunteers are trained to monitor all fever cases in their villages and basic equipment is provided to help diagnosis and treatment. Similarly the project strengthens the capacity of district health services and health professionals through training and the supply of equipment and essential drugs. Regular antenatal screening of pregnant women for malaria and anaemia is encouraged.
The project supports the establishment of health management information systems at district and sub-district health services and trains staff in data collection procedures, thus strengthening both the tracking of individual cases and the wider recording of malaria incidence.
Community-based malaria control
The establishment and support of Village Malaria Posts staffed by volunteers reinforces the importance of active local involvement in malaria mitigation and enables early identification and treatment of cases..
Broader awareness of malaria and control methods comes about place by promoting practices such as the proper utilisation of bed nets, covering the body when asleep and the use of natural insect repellents. Insecticide-treated mosquito nets are provided to under-five year old children and pregnant women though growth monitoring posts and antenatal clinics. Environmental measures to reduce mosquito breeding sites are encouraged.
Malaria in Pregnancy program
The prevention and control of malaria among pregnant and lactating women is addressed by the Centre of Motherhood Education (COME) approach to antenatal care. This approach rehabilitates malnourished children by supplementary feeding programs as well as teaching families how to sustain their children’s enhanced nutritional and health status.
Training in better food production and processing and support for women to initiate small scale income generation activities increase abilities to meet essential nutrition needs, an important factor in recovery from malaria.
Malaria, Anaemia and Nutrition Education Session (MANES) groups have been established in target villages and involve village health workers as well as traditional birth attendants and healers.
Decentralised malaria policy formulation development
The project encourages, and provides training to district governments to incorporate malaria prevention into general development planning. This is important as the spreading of malaria is often aggravated by non-health development interventions, such as road construction, forestry practices and water supply infrastructure.
A cross-border working group on malaria prevention and control has been established and includes representatives of government health departments, non-government organisations and UN agencies.
Sector : Health and Nutrition
Location : East Nusa Tenggara
Donor : European Commission
Project Period : October 2005 – September 2008
Page last updated October 22, 2008
