BCC for Malaria Control Increases Benefits and Value for Money
BCC increases the likelihood of a good return on investment for malaria programmes. It increases the likelihood that nets are used, ACT and SP are not wasted, and that IRS programmes reach their target coverage levels. BCC is used in malaria control to encourage families to hang and use their nets regularly, care for them and repair them when they're torn, or to create demand for replacing nets on a continuous basis or as part of distribution campaigns. Another key role is informing and mobilizing communities to work with IRS spray teams, to follow instructions during and after spraying, and then promote continued use of LLINs following spraying. Adoption of diagnostic testing of fevers by both consumers and providers is a necessary step for improved treatment and surveillance of malaria, and is critical for the success of the Test, Treat and Track (T3) initiative. BCC is also vital for creating demand for testing and to build trust in results, particularly when patients receive malaria-negative results and are unsure of what to do next. As malaria transmission dynamics change, malaria will cease to be the primary cause of fever and there is an urgent need to improve provider skills in communicating with and counselling patients. Communication campaigns that use interpersonal communication are recommended to improve treatment adherence and demand for and recognition of quality drugs. BCC promotes ANC attendance and IPTp uptake, and training in interpersonal communication is critical for improving the quality of care providers give pregnant women.
As countries scale up malaria control and the epidemiology of malaria changes, many areas are seeing decreased transmission and progress toward elimination. BCC continues to play important roles when transmission declines. For example, BCC promotes testing and treatment in hotspot areas within Zanzibar, and net and prophylaxis use for travellers, such as in Swaziland. BCC can encourage protective behaviours such as net use even when the risk of malaria is greatly diminished. To support malaria elimination, so-called "hot-pops," reservoirs of infection often not considered when planning control (often adult men, those that work at night, and travellers to endemic areas) will need to also be the focus of interventions, as described in a recent editorial in The Lancet. BCC is likely to be crucial for convincing asymptomatic individuals that testing and treatment will help them as well as their communities, and for informing communities about changes in the optimal timing of interventions and the use of new occupation-based vector-control products.