As the contributors to this thematic series point out, there are a number of ways
in which malaria should be reimagined in the lead up to elimination. Although community
engagement has long been recognized as a factor contributing to the successful control
and elimination of many infectious diseases, including malaria, in reality community
engagement has often played a marginal role within malaria control and elimination
programmes in the last 15Â years. This commentary points out five ways that community
engagement should be re-imagined, strengthened and re-strategized in the lead up to
malaria elimination. In the control era, a large volume of social science literature
discussed the benefits of community participation to malaria control, and some of
these benefits still apply in an elimination setting. In the control era, community
participation was seen as a means to: improve community uptake of prevention, diagnosis
and treatment 1], 2]; understand how local knowledge, belief and practice might influence the effectiveness
of interventions 3]–6]; support health promotion 7], 8]; add local knowledge to programmes 1], 2]; strengthen a primary health care approach to malaria control 2]; and increase equity within elimination and support the development outcomes of public
health programmes 1], 2], 9].
However while the concept of community participation was widely accepted during the
control era and was noted as a key element of Primary Health Care in the Alma Ata
declaration of 1978, some have noted that malaria programmes did not fully utilize
the benefits of community engagement 10], 11] especially as the pendulum swung in the MDGs period towards top-down approaches to
malaria in many settings. For example, it has been argued that most ‘community engagement’
activities within malaria control in Africa were not aimed at community empowerment
but rather more closely resembled top-down interventions that were motivated by a
desire to bring about patient compliance 11]. A systematic review of community participation in infectious disease control programmes
confirms that malaria control only partially implemented the principles of community
engagement 10]. While agreeing with critics that community engagement should not be seen as a panacea
to compensate for limitations in health systems or technology 12], systematic reviews of successful infectious disease control and eradication programmes
show that community engagement has often been a critical factor enabling successful
infectious disease control and elimination programmes 10], 13].
This commentary suggests that while community engagement is rarely recognized as an
important element of malaria elimination, that in practice a large number of activities
are already implemented at the community level that depend on support from communities
for success. Community engagement involves a wide range of activities along a continuum,
ranging from passive community acceptance at one end, to community ownership of elimination
at the other 14]. The authors argue that malaria elimination will be enriched if these existing activities
are recognized as a form of community engagement and incorporated into elimination
planning in a more strategized manner. The authors argue that while many features
of community engagement from the control era also apply to malaria elimination, that
elimination also presents new challenges that make active community participation
even more important for programme success. This commentary is not an exhaustive discussion
of these issues, but rather intends to begin this conversation by outlining five key
reasons why elimination efforts will benefit from re-imagining, strengthening and
re-strategizing community engagement.