2010 Velingara Malaria Prevention Campaign

Who: Collaboration between Peace Corps/Senegal, the NGOs Malaria No More, Tostan, and World Vision, the Senegalese Ministry of Health, along with 600 communities in the district of Velingara.

Where: The Health District of Velingara in the region of Kolda, in southern Senegal, with a population of over 250,000

What: Comprehensive malaria prevention campaign, including intensive public education effort and the distribution of 99,000 long-lasting, insecticide-treated mosquito bed nets. This village-by-village distribution ensured that every single bed, in every home, in every community in Velingara is covered by a bed net. This is the largest such effort ever in West Africa. This effort, along with the Peace Corps-led work in Saraya [link] has helped the Government of Senegal, in partnership with USAID and the President’s Malaria Initiative, to support universal coverage in 2010 for all of the southern and eastern Senegal regions with the highest levels of malaria: Tambacounda, Kedougou, Sedhiou, and Kolda.

Why: Malaria is the number one killer of children in Senegal. A snapshot of malaria prevalence in the Kolda region recently showed that at any one time 1 in 5 children carried malaria. Malaria also is extremely dangerous for pregnant women and chronic malaria sickness is a tremendous barrier to rainy-season productivity for everyone in the area. Universal coverage by treated bed nets designed to last 5 years, combined with a house-to-house effort to ensure that the nets are used and maintained properly, provides the best opportunity to substantially and sustainably reduce both deaths and sickness by preventing the disease from being spread from person to mosquito to person.

When: The nets arrived in Dakar in late December 2009 and were transported to a warehouse in Velingara in January 2010. The campaign kicked off February 22nd and bed net distributions are complete, except for the Health Post of Medina Gounas, which will be completed later this year. See below for the latest news.

Next Steps: Peace Corps Volunteers and their partners will facilitate efforts to maximize bed net usage and track changes in disease burden. Volunteers are also supporting the 2010 campaigns to extend universal coverage throughout the regions of Tambacounda, Kolda, and Kedougou.

Update: May 25, 2010

Nathaniel Miller, Peace Corps Volunteer

For the last few months Peace Corps/Senegal has been supporting a massive distribution of mosquito bed nets in the department of Velingara to achieve universal coverage. To date, nearly 100,000 nets have been put into the hands of needy citizens. With the partnership of local health workers, Malaria No More, World Vision, Tostan, and Peace Corps Volunteers on the ground, the distribution has visited nearly every village in the department, 600 separate communities.

By working closely with local health agents both in villages and in government health posts, the project has included education to ensure proper usage of the nets and to raise awareness of the causes of malaria and how best to prevent it. The also integrated innovative steps to deter people from selling their nets later or from using them for anything but bed protection.

Difficulties have arisen despite the preparation and hard work of the participants. Communication could have been improved from time to time between the partners and the local health agents. When the number of nets requested was found to be insufficient to cover local needs, more nets were allocated with the support of Malaria No More, the Senegalese Malaria Control Program, USAID and the President’s Malaria Initiative.

Despite the occasional missteps and misunderstandings, the population has been appreciative of our work. Whenever confusion arose, agents on the ground were able to create a solution that provided nets for everyone who needed them. By working closely with Peace Corps/Senegal administration and the partners who supported this effort, the program has become a model for the rest of Senegal.

A lot has been accomplished and learned in just a few months time. We are confident the results will be a dramatic improvement in the quality of life for the people of Velingara. Few people will get sick and fewer kids will die.

Update: April 21, 2010

Amanada Wybolt, Peace Corps Volunteer

I wasn’t surprised by how well things were running at the Velingara net distribution; before arriving, I knew that for a distribution on this scale to be pulled off successfully, it would take immense amounts of planning, collaboration, and tireless effort every day. As my first day helping out in Velingara came to a close, I saw that all of these aspects of the distribution were indeed true: volunteers awoke and were at the warehouse every morning by seven, sometimes not returning until five that evening, and the partnering organizations of Peace Corps, World Vision, Tostan and USAID shared information and pooled their resources to ensure that we reached every village that we needed to reach, every day.

What did surprise me while I worked at the distribution in Velingara, were the villages that we visited. It is one thing to say that you were part of an organization that covered an entire department so that every person would be able to sleep under a mosquito net. It is another thing entirely to travel to areas of the country that you otherwise never would and see people’s faces as you place a small stack of nets in their hands, or to get up and dance with a group of women you’ve never met in the middle of a causerie (health talk), or to sit on a mat next to a village Imam (religious leader) and scribble the name of his village on 600 nets.

Working at the Velingara net distribution gave me invaluable insights to the inner-workings of a successful, large-scale distribution. Because of my time spent in Velingara, I am excited and more prepared to face the challenges of the next distribution taking place in the department of Kolda, where I live. But even more so, I am excited to connect with the villages around me and influence their lives in a way I never could working alone in my village, as we did in Velingara. Here’s to universal coverage!

Update: April 19, 2010

Kris White, Peace Corps Response Volunteer, Velingara Senegal

We have finally completed Diaobe, the home of the largest market in West Africa. We distributed over 15,000 nets during the last 7 days in Diaobe, and though there were many bumps along the way, there is now a net over every sleeping area in that town.

What were the bumps you say? Well a 200 foot tall burning tree dropping 100 pound flaming branches along the only road out of Velingara was one, battling a case of bronchitis two, the transmission to my car dropping out onto the road three, so on and so forth.

Diaobe was our first major town, and it presented a new set of challenges. The main issue was how to get the right people to the correct distribution point, and there were 20 distribution points in just the main town alone (over 7,500 nets). Though there was some confusion, Peace Corps volunteers and our Partners worked diligently to rectify this issue, often working from 7am to 8pm. Malaria No More Project Coordinator Baro Diouf used the radio to clarify distribution points and reinforce the malaria education aspect of our program. District Health Workers returned into their respective sections of town to aid those who needed help. The chief regional doctor encouraged bednet use and made rounds amongst distribution points to make sure that his Health workers were writing on all nets with permanent markers (because Diaobe is the largest market town in West Africa, to avoid re-selling of nets on the black market, writing on nets with permanent markers was of the utmost importance). PCVs conducted malaria lesson plans to make sure people understood the importance of using nets. In all, our coordinated effort resulted in the most effective bednet distribution Diaobe has ever received.

The distribution will be on a break until mid-May for a multitude of reasons, after which the very big city centers of Medina Gounass and Velingara will be distributed to. Unfortunately, due to personal obligations back in the United States, I must return home before the distribution is completely finished; therefore, this will be my last entry on the website. I must say how honored I am to have come back as a Peace Corps Response Volunteer to participate in this ground-breaking distribution. The largest of its kind in West Africa and the first of its kind with such an intense educational component. I am confident that this distribution will dramatically reduce both the morbidity and mortality rates caused by malaria in Velingara, meaning that Peace Corps and its partners saved lives through this distribution.

I’d like to thank all of our Partner organizations that I’ve worked with over the last couple months (Health District, Malaria No More, World Vision, and Tostan), and especially thank Senegal Peace Corps Director Christopher Hedrick for bringing me back to participate in this distribution.

I will be following the distribution from afar in the States, I wish you all the best of luck and great success. Take care.

Update: April 7, 2010

Update from Camille Hogan, Peace Corps Volunteer

I am an Environmental Education volunteer in the Velingara district. It is great to finally see this project come to life after several months of preparation and meetings. Though we have had a few bumps in the road, they have all been learning experiences, and from what I have experienced so far, the distribution seems to be going smoothly.

I am impressed by the amount of community involvement and support from the NGOs working in the area. This distribution has been a collaborative effort and works well because of that. It is always refreshing when we see the relais give passionate causeries that capture the community's attention. The education component of this distribution is key. Without well-done causeries that inform the communities of the importance of mosquito nets and their proper care, the distribution would be ineffective. When the relais are enthusiastic about what they are teaching, community members listen and remember the important facts.

It is also great to see key figures in the communities become involved. It makes a difference when the chief of a village affirms what the relais is saying and chimes in by reiterating the importance of using a mosquito net. The more community members that are involved and show enthusiasm for the distribution, the more likely people are to continue with the use of the nets.

Also, the volunteers and staff members involved in organizing the distribution have gone to great lengths to see this through. It is encouraging to see them continue to come to work with a smile on their faces everyday. This has been an exciting project to participate in, and I am looking forward to visiting compounds in my village and seeing nets hung over the beds. This has also been a great learning experience as we prepare in the next few months the expansion of the distribution into other regions.

Thanks,
Camille

Update: April 6, 2010

Update from Chris Brown, Peace Corps Volunteer

Mosquito net distributions are difficult to plan and carry out, if you need someone to ask, just ask Kris White or Annicka Webster who’ve been carrying an even larger distribution in Velingara than what we did in Saraya. My experience in Velingara was definitely a positive one, despite almost getting caught in a riot concerning local soccer. They are really doing amazing work. The plannning that is going into the distribution is remarkable and is making the distribution go surprisingly smooth, considering its size. The ability to integrate so many partners has also been quite the accomplishment, and has contributed to the success of the distribution.

The planning, the execution, and the follow-up all need to be done well in order to achieve Universal Coverage, the goal of the distribution. I wish them continued success and courage in finishing up the distribution. Good luck.

Update: April 5 , 2010

Update from Annicka Webster, Peace Corps Volunteer

For me, one of the exciting parts of this distribution is working with different partners. First it must be said that without the help of local health workers (agents de santé communautaire and relais), this project would not be possible on such a scale. We are depending on them in each village for an accurate and well-conducted census. When a census is done well, the day of distribution is a breeze; when it is poorly done, making sense of the chaos created is an instant migraine. They are the ones who know the villages and are the key to getting as honest a picture of current net-coverage as possible. They’re also a necessary element on the day of distribution, organizing their communities and leading the educational sessions about malaria and net-care. It makes me think of the slogan: “I’d like to buy the world a Coke,” only in this case, I’d like to buy the relais an Africa Fun, to show my appreciation for the work they’re doing.

In a place where “on-time” can mean a couple of hours late, it is always encouraging to see the Tostan truck ready to load-up at 8 am on the dot. The driver is the most eager member of our fleet and as we get more and more practice setting up the demonstration distributions at each health poste, it is cool to see the drivers becoming more and more involved in the organization and helping explain the net-preparation to the health workers.

One of my favorite parts of the demonstration distributions is the World Vision facilitators. In lieu of a dry question-and-answer session about malaria transmission and net-usage, WV facilitators use a sketch to tell an Open-Ended Story. The story leads into a discussion of malaria and the role of nets in its prevention. The community comes up with possible endings to the story based on information presented. This creative approach to health education gets everyone excited about mosquito nets and usually ends in singing and dancing. I really enjoy hearing “Mosquito nets are here! Mosquitoes are on the run!” accompanied by the clapping and cheering of a dancing crowd.

Collaboration isn’t only necessary to make this kind of distribution possible, but it is also a part of keeping it going steadily and preventing any of us from burning out under the strain of such a large-scale project.

Update: April 1, 2010

Nathalie Fauveau, Charge de Communications World Vision Senegal

A Typical Distribution Day (in the village of Anambe-Couta):

The World Vision and Peace Corps trucks are filled to the brim with treated mosquito nets. Once in the village, the entire community is assembled around the main square, anxiously waiting. In hand, they all have the piece of paper with their name and the number of nets they requested. Only if they have this official slip are they be able to go back home with the nets. One of the local primary school classes is sitting in the shade of a tree. They have been invited to come and listen to their teacher teach them about malaria and malaria prevention. The life lesson takes about 40 minutes. Then, a couple members of the World Vision staff play out the open-ended story. After that, it is finally time to distribute the nets. They’ve all been spread on a tarp, organized in piles for each family. One by one, the community members hand their slip to a Health District Agent or World Vision staff member who finds the net(s) marked with their names.

Music, drums, dancing and laughter fill the air. Today, lives have been saved.

Full World Vision Document

Update: March 31, 2010

Update from Kristopher White; Peace Corps Response Volunteer; Velingara, Senegal

Folks, I’m happy to say that we are more than half way through this distribution (55 percent to be exact). Region-wide gas shortages, snakes in the warehouse and even riots in the city center of Velingara could not stop us from distributing over 45,000 nets to more than 400 villages since the beginning of the campaign.

News, and subsequent anticipation, of our region wide distribution is spreading fast. Yesterday, a woman preparing bean sandwiches wouldn’t serve me until I told her the exact dates that we would be distributing in her area. A soldier walking the streets stopped our car just to make sure his base would receive nets. The director of a large school visited by the World Vision office to be positive that his teachers were included in the correct net Census. It seems that the communication campaign, lead by our partners Malaria No More and the Youssou Ndour Foundation, is being well received.

Every day our warehouse, which once used to be packed to the gills full of mosquito nets, becomes a little more empty. Every day our partners unite in a combined effort to efficiently transport mosquito nets to remote villages. Every day PCVs, World Vision facilitators, and/or Tostan agents conduct malaria lesson plan trainings to enhance the capacity of community health workers in the field. Every day, net by net, Peace Corps and its partners are taking one step closer to eradicating malaria in Velingara.

Coming up we have to tackle the biggest zones in the Velingara region, one of which includes the largest market in West Africa (Diaobe). Wish us luck, and we’ll be sure to keep you posted.

Update: March 22, 2010

Update from Debbie Gueye, USAID President’s Malaria Initiative (PMI)/Senegal

Last week I visited Velingara to see how the bednet distribution is going and to gather lessons that we might apply to other parts of the country. The National Malaria Control Program (NMCP) has set the goal of achieving universal coverage with bednets by the end of 2010. Obviously this is a huge undertaking and will require the concerted effort of many partners. I travelled to Velingara with Youssoufa Lo, from NetWorks – a PMI-supported project that will have a significant role in supporting the distribution activities. We were joined later in the week by Dr. Pape Moussa Thior, Coordinator of the NMCP. We all got our hands dirty writing names on hundreds of bednets and we also had the opportunity to talk with many of the health system personnel and community outreach workers involved in the activity.

This experience has proven that it is indeed feasible to cover every sleeping space with a net on a large scale, but not without challenges. We learned that it is paramount to have a high quality census of sleeping spaces, which means having outreach workers who are literate enough to record the necessary information and who communities will allow to access their bedrooms. The workers must also be able to clearly communicate the intention of the activity so that people don’t hide or lie about the number of nets they already have – otherwise there would never be enough to go around. And of course, handing out the nets is not the last step in the process – the outreach workers will also be going back to houses in the weeks following the distribution to make sure that the nets are hung and that people are actually using them every night.

We’d like to thank all the Peace Corps Volunteers and other folks on the ground who took the time to explain things to us and answer so many questions. They are a very dedicated, hard-working bunch of individuals and we look forward to seeing the fruits of their efforts in the form of notably reduced malaria cases during this coming rainy season.

Update: March 11, 2010

Update from Amber Patterson, Peace Corps Volunteer

I am a Peace Corps Health Education Volunteer in the district of Velingara, Health Post of Saare Coly Salle, village of Kountanto. Since the start of this universal coverage campaign, I have consistently participated on distribution days. My main role, along with fellow PCV partner-in-crime Annicka Webster, has been to provide "malaria lesson plan" training to local Health District volunteers. We coordinate with all Health District village level health workers, who volunteer their time for preventive health education in their communities, to convene at the main regional health post.

We discuss key points of the malaria lesson plan with the village health volunteers, which they conduct in their respective villages. Fundamental elements of these malaria lesson plans include: prevention, transmission, treatment and myths concerning malaria; the concept of universal coverage; and the importance and methods of writing the village name, year, and household name on each and every net distributed. This training of trainers is a key aspect of the success of this distribution because it reinforces the capacity and important role of local Health District volunteers.

Other Peace Corps Volunteers and I are to conduct two additional lesson plan seminars in the following week. My hope is that this transfer of knowledge will continue to have a positive effect on the local populace.

Update: March 9, 2010

Update from Kris White, Peace Corps Volunteer:

The universal coverage bednet campaign is well under way -- three Health Posts (Kalifourou, Linkering, and Paroumba) have been completed. Over 10,000 nets have been distributed already, providing universal coverage protecting over 30,000 people from malaria.

Since February 22nd , Peace Corps and its partners (Ministry of Health, Malaria No More, World Vision, and Tostan) have been working hand-in-hand every day to push this landmark campaign forward smoothly and efficiently. This week, our hope is to cover the Health Posts of Pakour and Boncoto. We plan to distribute more than 6,500 bednets to 67 villages.

The District of Velingara will soon have a long-lasting mosquito net over every bed.

(Kris is a Peace Corps Response Volunteer, who from 2006-9 served as a Health Volunteer in northern Senegal, then as a Volunteer Leader in Dakar. He recently returned to Senegal to help coordinate the Velingara campaign. See here for more on Peace Corps Response and how Returned Volunteers can serve again: http://www.peacecorps.gov/index.cfm?shell=resources.returned.response )

Update: February 23, 2010

Update from Chris Hedrick, Country Director, Peace Corps/Senegal

Here in Velingara, things are moving. We kicked off the bed net distribution campaign this week, and finished education and distribution to 23 villages over the past two days. 578 more to go before Velingara has universal coverage!

Peace Corps Response Volunteer Kris White, who earlier served three years as a health Volunteer in Senegal, has returned to help coordinate this effort. He is working with all the local Peace Corps Volunteers, and staff from Malaria No More, Tostan, World Vision, and the Velingara health district, to get things organized and underway. It’s great to work with Kris again.

This effort builds upon the model Peace Corps Volunteers established in providing universal bed net coverage in the southeastern Senegal health district of Saraya. Thanks to support from the NGOs Malaria No More, Against Malaria, Net Life, and Tostan, Saraya was the first ever health district in Senegal to have universal coverage of bed nets. Early examination of malaria prevalence statistics shows that the disease burden is already dropping.

Velingara is a bigger and more complex challenge than Saraya, though. 230,000 people live here, spread out over 600 villages and towns. Velingara shares borders with three nations—The Gambia, Guinea, and Guinea-Bissau—and hosts West Africa’s largest weekly market in the town of Diaobe. This makes prevention of black market resell an important challenge.

Here’s a quick update on where the project stands:

All the nets were safely transported from manufacturer to Dakar and moved to a secure warehouse in Velingara in January.
Peace Corps, Malaria No More, Tostan and World Vision, along with the health district, have agreed upon a standard methodology for distribution in Velingara which includes:

Training of village health workers for each of the 17 health posts in Velingara in net distribution logistics and malaria prevention training discussion
House by house census taking of bed net needs by village health workers, sent into each health post and project coordinators in advance of distribution
Village by village distribution of nets by partners
In each village, marking of each net with name of village, year, and name of family head, to reduce resale opportunities
In each village, in-depth malaria prevention and bed net use and care discussion led by village health worker
Follow up hang check efforts

February 22nd and 23rd, distribution was completed in the 23 villages of the first health post, called Kalifourou. We learned some lessons, but largely it went smoothly.
The week of March 1st, we anticipate distributing to 100 more villages and continuing until the campaign ends. The team is now completing the day-by-day, village-by-village detailed calendar for the rest of the campaign.
Once complete, this will be the largest universal coverage distribution completed in West Africa. The team will document the processes and ensure that we share all the lessons learned, producing a playbook for future efforts.
The Senegalese government and the President’s Malaria Initiative (the U.S. Government inter-agency effort to combat malaria across the globe) are now looking at this effort as a potential model for future universal coverage campaigns here and across the continent. For the first time Peace Corps, NGOs and local governments and village-based health workers are teaming up to achieve a shared goal: eliminating malaria.

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