Malaria Social and Behaviour Change Program Guidance in the Context of COVID-19 Pandemic

"...not only an unprecedented public health emergency but also an unprecedented opportunity to engage the audience in new ways..."

In the context of the COVID-19 pandemic, the RBM Partnership to End Malaria (RBM) Social Behaviour Change (SBC) Working Group developed interim guidance for malaria SBC to complement "Tailoring Malaria Interventions in the COVID-19 Response", which was issued by the World Health Organization (WHO) Global Malaria Program (GMP) on April 9 2020. The RBM SBC Working Group document identifies general behavioural considerations for implementation of the WHO GMP guidance, as well as corresponding malaria SBC recommendations for campaign-style malaria prevention interventions and malaria service delivery interventions. Information on factors such as channel selection, alternative activities, rumours and stigma, and gender is also included.

Broadly, "the RBM SBC Working Group recommends that community-level SBC activities that involve interpersonal communication or convening people in one place, such as social mobilization, community engagement, community meetings, or household visits that are conducted for the sole purpose of promoting the uptake of malaria prevention, testing, and treatment be temporarily curtailed in favour of mass, mid-, digital, and social media approaches. When conducted in conjunction with life-saving malaria prevention, testing, or treatment,...it may be appropriate to move forward with community-level SBC activities...". However, such activities "should only be pursued after careful review of WHO and national COVID-19 guidelines, discussions with relevant stakeholders, and careful consideration of the safety of those conducting and participating in community-level SBC activities."

The resource outlines these considerations for malaria SBC in the COVID-19 context:

1. Channel Selection - As noted here, partners should prioritise communication channels that avoid group congregation, which means reshaping many malaria programme activities. A table looks at each channel and details, for example, advantages, disadvantages, examples, and considerations for co-messaging with COVID-19 (either inserting malaria messages into planned COVID-19 SBC or vice versa). The table is meant to assist programmes in thinking through which channels to use for their malaria activities during the COVID-19 pandemic.
2. Innovation and Adapting Activities - Sample recommendation: "Do not simply reprogram your community activity plans to be entirely one-way radio spots or television. It is a well-established best practice that the interactive component of SBC activities is important for impact, so consider increasing call-in shows, phone-based competitions, virtual personal contact platforms or shifting in-person house-to-house visits to phone calls or other innovative approaches."
3. Rumours and Rumour Management - Sample recommendation: "Countries should establish a rumour tracking system for malaria in the context of COVID-19 and develop messages to respond to rumours. Early planning to anticipate possible rumours in the local context must be done, a mitigation plan put in place, and a response plan developed and ready for immediate roll out once rumours are discovered. Mitigation of rumours must be done through a strong multi-channel strategy to ensure that clear, correct, and actionable information is communicated."
4. Stigma - For example: "Since malaria and COVID-19 share symptoms, it is reasonable to anticipate that those with fever might be reluctant to report to a health professional for diagnosis, lest they be diagnosed with COVID-19. Proactively echoing the anti-stigma efforts of any ongoing COVID-19 campaigns may...help to maintain care-seeking and prompt access to malaria case management during the pandemic."
5. Gender - For example: "With more countries imposing quarantine/lockdown policies, households are placed in higher stress environments and there are increased opportunities for domestic abuse. In this context, malaria would probably not be a priority area of concern for those mothers, SBC interventions should consider focusing on raising risk perception of malaria among male heads of households."
6. Chloroquine/Hydroxychloroquine - In short: "At this time, SBC messaging on the use of chloroquine for COVID-19 is not recommended and messaging on the use of chloroquine for malaria should follow the country's malaria case management guidelines prior to COVID-19."
7. A Reminder of the Importance of Context - This section offers a few reminders of the complicated intersection between global guidance and the reality "on the ground". Malaria partners are encouraged to share their experiences and ways in which they have been addressed on Springboard for SBC, the RBM SBC WG's online platform.

Following these considerations is SBC guidance for malaria prevention interventions (insecticide treated nets [ITNs], indoor residual spraying [IRS], and seasonal malaria chemoprevention [SMC]) and malaria service delivery interventions (case management and malaria in pregnancy). Grounded in theories of behaviour change, this guidance is provided in the form of a series of tables listing behavioural determinants. The hope is that malaria SBC programmes can aim to leverage or change these determinants through their activities and messages in order to promote the behaviours more effectively.

This resource is meant to be a "living document" that will be updated as lessons and experiences with conducting malaria SBC during the COVID-19 response flow in from those working on the ground. Any contributions or input to future iterations should be directed to the RBM SBC WG Secretariat: lyndsey.mitchum@jhu.edu