Seasonal mobile workers and malaria in Ethiopia
In Ethiopia, seasonal mobile workers have been left out of the national efforts to reduce malaria, although they are particularly vulnerable to the disease. In the Amhara region, where many of them flow every year to work in agriculture, Health, Development and Anti-Malaria Association (HDAMA), a local Ethiopian organization with deep community roots, and the Malaria Consortium, a global leader in malaria control and elimination, have designed a targeted project to address the needs of these workers.
A joint interivew of Seyum Mengesha, Malaria Programs Coordinator at HDAMA & Tedila Habte, Country Technical Coordinator at Malaria Consortium Ethiopia :
What is the current malaria situation in Ethiopia?
Tedila Habte: It has improved remarkably in the recent years. Between 2016 and 2019, malaria morbidity and mortality have been reduced by 47% and 58% respectively1. Working hand in hand with international partners, the Government has designed a National Malaria Elimination Strategic Plan with an ambitious yet achievable objective: eliminating the disease by 2030. The work is done step by step. By 2025, the objective is to reduce malaria morbidity and mortality rates by 50% and to achieve zero indigenous cases in some districts.
What particular problems are there in the Amhara region and its five districts, where your joint project will be implemented?
Seyum Mengesha: The Amhara region is a productive agricultural area of the lowlands, where malaria remains a weighty issue. Every year, many seasonal mobile workers from the highlands travel there to work, then come back home. The highlands are free from malaria, so these workers don’t know much about the disease and have low immunity: as a result, they contribute up to 80% of all annual malaria cases reported in the region2. To make things worse, they have no access to health services near the farms they work at. Ethiopia’s Strategic Plan indicates that these communities need more focus and require a tailored approach, but it doesn’t translate on the ground: coordinating action is complex, because responsibility and accountability are to be considered across different stakeholders, from farm owners to regional health bureaux. This context led us to design a dedicated joint project, supported by L’Initiative and entitled “Reducing malaria burden among seasonal mobile workers through innovative approaches in the Amhara region”.
What are the main objectives of this joint project?
T. H.: We intend to reduce malaria morbidity and mortality among seasonal mobile workers by 30% by 2025. To do so, we must increase the coverage and quality of malaria services provided to these populations, from malaria diagnosis and treatment to disease surveillance and response. We need to increase the demand and uptake of malaria preventive and treatment services, which are very low. Besides, we want to advocate for the development of an implementation manual for policy makers, to improve the provision and coordination of malaria prevention and control services to seasonal mobile workers. We will start by raising awareness to build a consensus, then we will develop the manual. Finally, we want to enhance the role of seasonal workers themselves in shaping malaria control activities. Until now, they have never been involved in malaria prevention and control services. And we can’t succeed sustainably without them.
What’s your strategy to reach these goals?
T. H.: We are working in line with the National Strategic Plan, but we customize our approach to this very specific context. For example, as health facilities are located far from the farm areas where seasonal mobile workers live, we will train health workers to deploy on location on a regular basis, to provide diagnosis and treatment. This approach is actually pioneering. It is made possible by HDAMA’s close connection to Ethiopian’s society at local scale.
S. M.: Indeed, over the years HDAMA has gained the trust of local communities in the region, and of seasonal mobile workers more specifically. Knowing this group so well allowed us to design a targeted, customized intervention, finding the right approach to raise awareness on the issue of malaria and define the right modalities of intervention. Building the capacities of local stakeholders is also a pillar of our strategy. That’s why Malaria Consortium, with its technical expertise, is such a valuable partner. As we are about to launch the project in the next few months, I’m convinced that this hand-in-hand, targeted approach will teach us important lessons. As the recent civil war has resulted in many displacements across our country, learning how to tailor our approach to these mobile populations is essential.
1. FMOH: National Malaria Elimination Strategic Plan: 2021-2025, Addis Ababa, August 2022.
2. Zone Health Department annual reports, 2021.