By APLMA, 16 August 2021
In December 2020, with Pakistan in the grips of the pandemic, 8,000 volunteers in the country’s restive tribal region managed to distribute nearly 1.5 million mosquito nets to more than half a million households in the country’s remote tribal areas without contracting a single known case of COVID-19. How they did it offers a valuable lesson about how health authorities, by collaborating with communities and other stakeholders, can keep new health threats from disrupting the ongoing battle against other life-threatening diseases, including malaria.
While the pandemic has directly affected the economy, lives and livelihoods of millions, it has had a domino effect on the efforts to prevent other communicable diseases such as malaria, HIV and tuberculosis. The Covid-19 pandemic is putting enormous stress on healthcare systems in countries with limited resources, Covid-19 has hindered their ability to respond effectively to these communicable diseases. The pandemic and countries’ efforts to contain it have disrupted the delivery of essential health services and commodities.
With nearly a million confirmed Covid-19 cases (978,847) and almost 23,000 (22,642) deaths as of mid-July, Pakistan reached the peak of its own pandemic in mid-June. Measures by the government have flattened the curve. Pakistan went into a nationwide lockdown in April 2020, which was then extended until May 9, 2020. After the first wave of cases, the lockdown was eased and, since then, Pakistan has been implementing “smart lockdowns”—short-term restrictions at Covid-19 hotspots, based on surveillance data—to curb the spread of the virus. Smart lockdowns, while allowing for the economy to recover, also enabled health programs to resume delivery of essential health services by allowing health workers outside targeted hotspots to remain mobile.
But in the pandemic’s early stages— from late May to mid-July 2020—the pandemic and measures to contain it had a profound impact on malaria elimination efforts. The nationwide lockdown led to the closure of healthcare facilities and a 30% decline in screening of suspected malaria cases. Because many of the symptoms of malaria and Covid-19 are similar, patients were reluctant to seek treatment due to fear of being misdiagnosed with Covid-19 and forced to isolate. To reduce this fear, the government issued Covid-19 advisories to the general population, encouraging anyone ill to seek treatment. There was a shortage of protective gear, such as personal protective equipment (PPE) kits, sanitizers and masks for health workers, but once supplies were replenished, the delivery of essential health services resumed. Face-to-face training and capacity-building programs, supervisory visits, mass awareness and distribution campaigns were disrupted as well. In-person training eventually resumed, albeit while observing social-distancing rules, which reduced the number of participants and training time.
Pakistan’s malaria program turned to alternative media, including WhatsApp, radio and mosque announcements, to carry out mass awareness campaigns. As the pandemic first unfolded in Pakistan in May and July of 2020, when some project activities such as field data validation were delayed, social media channels were eventually used to share and validate data.
Another vital success story in Pakistan’s efforts to fight malaria amid the pandemic was its Long-Lasting Insecticidal Nets (LLIN) distribution campaign in its very challenging tribal areas (referred to as Merged Tribal Areas (MTAs), where roughly 5 million people in 558,300 households live across a rugged and remote territory covering 27,500 square kilometres on Pakistan’s northwest border with southern Afghanistan. Years of conflict in the region have made it a particularly difficult place to deliver health services. Historically, access to healthcare in this region has remained poor, compounded by a weak public health infrastructure, shortage of healthcare providers, limited utility services and security concerns. As a result, MTAs reported the highest Annual Parasite Index (API) of 12.9 in Pakistan in 2019...