Evaluating a Community Engagement Model for Malaria Elimination in Haiti: Lessons from the Community Health Council (CHC) project (2019-2021)

Abstract

Abstract Background: Community engagement (CE) plays a critical part in malaria control and elimination efforts. However models of CE for malaria vary substantially, with more participatory approaches requiring higher levels of adaptive management in program design and implementation. In this paper, we evaluate the effectiveness of a volunteer-based CE model developed in Haiti in 2018. This model facilitated local leaders to organize and implement monthly anti-malaria activities in their communities and was implemented as part of the Malaria Zero consortium activities. Methods: This program evaluation draw on quantitative and qualitative data collected from 23 Community Health Councils (CHCs) over a two-year period (2019-2021) in Grand’Anse department, a malaria hotspot region in Haiti. Results: Monthly monitoring data showed that 100% of the 23 CHCs maintained functioning over the two-year period, with an average of 0.90 monthly meetings held with an 85% attendance rate. A high degree of transparency and diversity in membership helped create strong planning and involvement from members. CHCs conducted an average of 1.59 community-based activities per month, directly engaging an average of 123 people/month, with high levels of fluctuation indicative of local ownership and self-organization. This included school and church sensitization, environmental sanitation campaigns, mass education, support for case referrals and community mobilization during mass drug administration (MDA) and indoor residual spraying (IRS) campaigns. Members drew on the tradition of konbit (mutual self-help), local histories of health and development campaigns and a lexicon of “solidarity” in difficult times as they negotiated their agency as community volunteers. Small incentives played both symbolic and supportive roles and some level of politicization was viewed as inevitable, even beneficial. Rumours about financial and political profiteering of CHC volunteers took time to dispel while the tendency towards vertical planning in malaria control created conditions that excluded CHCs from some activities and generated resentment from members who felt sidelined by the government malaria program. Conclusion: The CHC model was effective in promoting group solidarity and community-based anti-malaria activities over a two-year period in Haiti. With the end of the Malaria Zero consortium in early 2021, there is now an opportunity to better integrate this model into the primary healthcare system, evaluate the impact of the CHCs on malaria epidemiology, and promote the greater integration of CHCs with active surveillance and response activities.