Back to the Basics: Working Together to Eliminate Malaria in Uganda
World Malaria Day provides an opportunity to raise awareness about malaria and how, with everyone's contribution, from individuals and communities to the provincial and national levels, it can be controlled and eventually eliminated.
"Everyone should go back to the basics and pitch in," said Constance 'Connie' Agwang, the malaria technical officer for MCD Global Health (MCD)'s U.S. President's Malaria Initiative (PMI) Malaria Reduction Activity (PUMRA) in Uganda, funded by USAID and led by JSI.
"We have all that we need to eliminate malaria. What we need to do - as individuals, as families, as communities, and as a population - is to go back to the basics: constant education and reminders that we can do this," she said. "When everyone takes personal responsibility, then it becomes a collective responsibility, and, before you know it, everybody is doing their part, and malaria is eliminated."
Since July 2022, Agwang has led the PUMRA's MCD team in Uganda and is the main contact with the Uganda Ministry of Health to ensure PUMRA reaches its goals, which is to improve the prevention, diagnosis, and treatment of malaria in Uganda with a focus on strengthening the capacity and ownership of malaria prevention at the community and household levels.
"My role involves being flexible and addressing where the needs are," Agwang said. "If there's a need that involves the ministry, I step in; if it involves technical support, I step in; and if it involves administrative issues with the MCD team, I step in."
For PUMRA to be successful, capacity must be strengthened at the national and subnational levels, but also at the community levels of Uganda's health system.
Community Driven Solutions
"A case-in-point is that the Busoga sub-region had an upsurge in malaria cases around the time PUMRA was launched; they were already at an epidemic-level," Agwang said. There were many deaths happening in the community and health facilities and the health system were grappling with how to manage the situation. "Once our team arrived on site, they made sure that the facilities were able to provide quality services, an area that MCD has immensely contributed to."
"We have to bring the community on board, so the community takes ownership of these interventions because that's where prevention is done," she explained. "Once communities learn and apply all these interventions, then you'll see a reduction in the burden of patients at facilities as well as a reduction in the number of malaria deaths."
From the PUMRA team's efforts, health facility staff were equipped with the skills and knowledge they needed, and the facilities were better able to manage cases; which led to a sharp reduction in malaria deaths. Since these gaps were addressed, the team can now focus on working with the community to address prevention and early health-seeking behavior.
Along with involving all levels of governance and health system in the country to build capacity and mitigate malaria and its effects, maintaining gains in malaria case management is also a focal point of PUMRA. This involves ensuring that the quality of services and treatments are maintained and improved at the facility-level through availability of medicines and all relevant commodities, training health care workers, and more.
"Making sure that vulnerable populations can receive services, which includes children, pregnant women, and others, is a priority" she said.
Part of this involves MCD's contribution to PUMRA where the team ensures that health facilities can provide these high-quality services, build capacity of health care workers and facilities through training, and provide onsite mentorship and supportive supervision.
"I can say that MCD's contribution to the PUMRA as well as to the country's goal of morbidity and mortality reduction by 50% and 75%, respectively, has been recognized and appreciated," she added.
Originally from Uganda's Pallisa District, Agwang is no stranger to malaria. Since childhood, she has always wanted to make helping people who are sick or at-risk part of her career and lifelong goal.
"I was a sickly child, and I remember how my dad would sit with me at the hospital and throughout the night taking care of me," she said. "I would see and interact with doctors and other sick people, and those experiences shaped what I wanted to do in life: to help people, help sick people."
Such experiences influenced her to pursue education in the medical field where she attained her bachelor's degree in medical laboratory science, a master's degree in molecular biology, and another master's degree in public health from New York University.
"My research thesis for my master's was vaccine candidate antigens for malaria where I was looking at three vaccine antigens," she said. "One of them is circumsporozoite protein (csp) that forms the major component of the WHO-approved RTS,S malaria vaccine, which Uganda will roll out in 2024."
In addition, Agwang has also completed numerous courses on project management in global health at the University of Washington and additional courses on epidemiology, behavior change communication, emergency response, and global health security.
In terms of how she feels about the future of malaria in Uganda, one challenge to eliminating and preventing this disease is due to how long the disease has been around and, because of that, people have become too familiar with it.
"People are so used to it, despite the fact that it kills so many people," she said. "In addition to raising awareness, we need to keep reminding people that this is something we can manage and control. We can eliminate malaria if we all combine our efforts and give it the attention it deserves."
This, as Agwang stated earlier, involves "going back to the basics," which involves affordable and easy-to-do solutions at the individual level. With assistance from USAID, MCD, and other partners through PUMRA and other initiatives, such goals can be achieved at all levels of Uganda.
"I am really thankful for all the support that we have received as a country to fight malaria, and we don't take that for granted," she said. "We are grateful for the support that has come from the U.S. government, and other partners and governments, and I want to say thank you to all partners that have supported Uganda as a country to address the malaria issue."