Kyunsu township, on the largest island in the Mergui Archipelago in the Thanintharyi region of southern Myanmar, is an area at high-risk of malaria.
The main local economic activities, fishing and rubber tapping, put local residents here at even greater risk of the disease as they involve working between dusk and dawn: the hours during which anopheles mosquitoes, the species that carry malaria parasites, bite.
The island residents also have very restricted access to resources in Kyunsu township and, in particular, to health care.
In early 2013 Malaria Consortium launched a pilot programme here, testing an innovative community-based approach to malaria control. The approach, known as "positive deviance", aims to promote positive knowledge, attitudes and behaviour for improved malaria prevention and control. It involves identifying local positive deviants or people within the community who are already demonstrating positive, preventative and care-seeking behaviours for malaria, and empowering them to share those behaviours with the rest of their community.
"They are deviants because they are deviating from the norms and they are positive because they are engaged in behaviours that result in better outcomes," Muhammad Shafique, behaviour change communications specialist at Malaria Consortium, explained to regional partners at a recent seminar on malaria elimination. You can view his full presentation here.
"When people see someone from their community who, despite living in similar conditions, sharing similar resources, has managed to avoid the same health problems suffered by their neighbours, they become social proof that behaviour change can impact on health. That expedites the process of behaviour change," added Shafique.
Positive deviance has already been implemented in various countries and with a number of health issues – including malnutrition, health of newborns and HIV/Aids. However, Malaria Consortium is the first organisation to implement the approach for malaria prevention and control in Cambodia since 2010 and in Myanmar since early 2013.
So far the results have been extremely good. Communities and the positive deviant volunteers have reported some successes and demonstrated ownership over the project.
"Since I became a community volunteer, working to take care of my village's health, I have gained their trust and respect and that makes me feel very happy," said Htay Aung, a positive deviance volunteer in Myanmar.
A local solution to a global problem
Despite a dramatic decrease in malaria cases and deaths in Asia in recent years, since 2008 there is growing evidence of the emergence and spread of parasite resistance to artemisinin, the major component in anti-malarial drugs. To date, parasite resistance has been identified in four countries in the Greater Mekong Sub-region: Cambodia, Thailand, Viet Nam and Myanmar.
"If resistance were to spread through Asia to Africa, as it did in the 1960s, it would be a major setback to global efforts to control malaria," Dr Sylvia Meek, technical director at Malaria Consortium, says. Many experts and governments in the region now agree that the threat is significant and suggest that stopping the spread of resistance will require the elimination of malaria from the region entirely.
With malaria particularly prevalent amongst mobile and migrant populations in the region, especially those engaged in forest work such as rubber tapping, reaching out to those groups is essential. In both Kyunsu, Myanmar and Pailin, Cambodia, Malaria Consortium has found the positive deviance approach to be particularly successful in engaging the mobile and migrant population.
The organsation's experience in implementing positive deviance for malaria control in Asia to-date is outlined in a recent learning paper available to download here.
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