The Last Mile to Malaria Elimination: Confronting Gender Inequalities & Power Dynamics

Young girls chat while sitting under a mosquito net in Bienythiang, South Sudan. Credit: UNICEF/Mark Naftalin
  • Opinion by Kipkemoi Saitabau, Arthur Ngetich Kipkemoi Saitabau (kuala lumpur, malaysia)
  • Inter Press Service

World Malaria Day, April 25, is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. It was instituted by WHO Member States during the World Health Assembly of 2007.

Women are at higher risk of malaria due to biological, social, economic, and gender factors. They have limited access to healthcare, less decision-making power and control over household resources, which increases their susceptibility.

Gender-based economic disparities further worsen the situation by limiting women’s access to malaria prevention and treatment.

While significant progress has been made in the past decades in combatting malaria through the development of life-saving treatment regimens and the implementation of cutting-edge technologies to accelerate the discovery and development of new malaria vaccines, deaths due to malaria remain high.

In 2021 alone, an estimated 619,000 deaths were caused by malaria, highlighting the need for continued efforts to combat this disease.

In addition, COVID-related disruptions in the delivery of malaria curative and preventive services during the two peak years of the pandemic (2020-2021), led to approximately 13 million more cases of malaria and an additional 63,000 deaths caused by the disease compared to the pre-COVID-19 year of 2019.

To date, malaria cases and deaths have primarily been reduced through disease-focused approaches that tend to be reactive rather than proactive often initiated in response to malaria outbreaks.

This narrow focus on treating individual cases of malaria overlooks broader social, economic, environmental risk factors including gender-based inequalities.

As Member States work towards ambitious goals set during the 2015 World Health Assembly of reducing the global malaria burden by 90% by 2030, efforts need to prioritise the underlying factors that drive transmission through a multifaceted approach, particularly recognising the social determinants like gender inequalities.

The concept of people-centred health care is based on fundamental principles that prioritize human rights, dignity, participation, equity, and partnerships.

This approach aims to create a health care system where individuals, families, and communities receive humane and holistic care, while also having the opportunity to actively engage with the health care system.

As we work towards leaving no one behind and achieving the last mile, developing and adopting more people-centred approaches, that address gender and intersectionality concerns through an analysis of power dynamics, will be critical to make significant strides towards eradicating malaria for good.

This can involve engaging with communities and stakeholders to identify their needs and develop evidence-based malaria control strategies that promote equity and inclusion.

Additionally, promoting participation of marginalized groups in decision-making and ensuring malaria interventions respect human rights and promote social justice.

Not only will this help advance Sustainable Development Goals towards gender equality but importantly will also contribute to decolonising global health and empowering communities that remain most impacted by the disease.

Unpacking the Gendered Dimensions

A people-centred approach to malaria prevention aims to prioritize the well-being of individuals and communities by establishing reliable health systems. However, power dynamics must be taken into account to prevent the perpetuation of power imbalances, hierarchies, and inequalities.

This means engaging with communities and other stakeholders to identify their needs and priorities and working together to develop evidence-based malaria control strategies.

The Community Directed Intervention (CDI) approach exemplifies the importance of extensive community engagement to identify local needs and priorities for malaria control. This includes community meetings, involving leaders and women groups, and conducting surveys on malaria burden and risk factors.

Developing evidence-based strategies through community engagement results in increased community ownership and participation, leading to higher uptake of interventions and reducing malaria transmission.

Addressing the power dynamics associated with malaria prevention requires acknowledging and tackling gendered dimensions linked with malaria prevention.

Women in some communities may lack access to education, employment, and decision-making power, which can limit their ability to protect themselves from malaria.

Additionally, cultural beliefs and practices may contribute to the unequal distribution of resources for malaria prevention and control, with men accessing more resources than women.

This underscores the importance of addressing gender roles in malaria control initiatives and empowering women to take an active role in protecting themselves and their families.

Intersectionality also has important implications for malaria control as gender intersects with other social categories to create specific vulnerabilities and challenges. For instance, women from lowest income groups are least likely to get access to healthcare.

To address these challenges, it is important for more malaria control programs to conduct systematic social and gender analysis, hearing from those affected, to better understand the subtle nuances of gendered and intersectional dimensions of power both within households and communities.

This approach can then help to identify the specific barriers and opportunities for women's participation in malaria control initiatives. By unpacking the gendered dimensions in communities, public health officials can design targeted interventions that promote women's empowerment, address gender inequalities, and increase women's involvement in malaria control programs.

Confronting not Reinforcing Power Dynamics

A people-centred approach to malaria control can empower individuals by providing education and training on malaria prevention and control. It can emphasize inclusivity and centre the experiences and knowledge of those who have been historically excluded or marginalized due to factors such as racism, sexism, classism, and other systems of power.

To avoid reinforcing power dynamics in malaria control, it is crucial to involve and empower marginalized groups in decision-making. This involves consulting communities to identify their needs and priorities, promoting participation of women and marginalized groups, and designing interventions that promote equity and inclusion.

The foundation for improving community dialogue and community-led actions towards malaria elimination has been established over the years.

A case in point is the successful elimination of malaria in Cambodia's last mile, which relied on communities in high-risk areas agreeing to increased testing, regular fever screening, and in some cases, taking preventive antimalarial medication.

A people-centred approach recognizes the significance of communities in designing and implementing malaria control programs, considering their unique social, cultural, and environmental contexts that can impact malaria transmission and control.

One illustration is the use of local languages and cultural practices to build trust and improve communication on malaria prevention and control measures through empowerment of community health workers who understand and can tailor interventions to their specific contexts.

On the other hand, a people-centred approach, which does not consider power dynamics, can unintentionally reinforce social hierarchies and exclude vulnerable populations from accessing preventative and curative treatment for malaria.

For instance, a malaria control program that only involves male community leaders and village chiefs in decision-making when distributing bed nets reinforces patriarchal power and favour wealthier households, while excluding marginalized groups such as women and those from lower socio-economic backgrounds.

In conclusion, achieving malaria elimination through people-centred approaches requires a holistic approach that actively considers issues of gender, intersectionality, and balance of power. It is crucial to ensure that these approaches do not perpetuate existing inequalities, but instead centre the experiences and knowledge of marginalized groups.

By acknowledging and addressing the ways in which different forms of oppression intersect and compound to create experiences of marginalization and exclusion, we can make meaningful strides towards malaria elimination.

To achieve this, sustaining a commitment to inclusivity, equity, and social justice is imperative in all efforts aimed at eradicating malaria and improving the health and well-being of communities affected by this disease.

This includes actively involving marginalized groups in decision-making processes, addressing social determinants of health, tailoring interventions to specific cultural and contextual factors, and promoting gender equality and women's empowerment.

By taking a proactive and inclusive approach, we can ensure that malaria control efforts are effective, equitable, and sustainable, leading to more just and healthier communities.

Arthur Ng'etich Kipkemoi Saitabau is Post-Doctoral Fellow of the United Nations University - International Institute for Global Health.

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