Understanding the social determinants of access to malaria services

Empatika kicked off 2021 with a study about malaria programs in Eastern Indonesia,

During the adapted immersion, researchers continued to use some of our typical immersion tools such as making community maps with children

focusing on the social factors that influence how people access malaria prevention and treatment services. Even though malaria programs have been delivered nationwide since 1959, with a more recent target to achieve malaria-free status by 2030, malaria cases remain high especially in the eastern part of Indonesia. This study aims to provide deeper insights and a better understanding of community experience in order to strengthen existing malaria interventions, particularly communication strategies that can encourage positive behaviour in using malaria prevention-related services.

For this study, the Empatika team visited four districts including Southwest Sumba, NTT; Mimika and Jayapura, Papua; and Manokwari, West Papua. Within each district, our team spent time in two different communities.

The study was carried out in two stages including adapted immersions along with follow-up People Driven Design (PDD) workshops. The first stage using adapted immersions was done in mid-January—the method was adjusted from Empatika’s typical immersion approach to mitigate COVID-19 risks to both participants and researchers. For these adapted immersions, researchers visited communities from morning until evening over a period of days but spent nights at a guesthouse close to the community rather than staying with families. During this stage, we focused on understanding the local context and people’s behaviour in relation to malaria prevention and treatment.

The second stage included People Driven Design (PDD) workshops in communities that took place in early March. PDD is an approach based on the principles of human-centred design with an emphasis on directly engaging people in identifying their own behaviour challenges, setting goals, and developing their own ideas to encourage positive behaviour change. For these workshops we focused on one community each across the four districts. Building on the rapport built throughout the adapted immersions, Empatika researchers held interactive discussions with a group of community members and health providers over a period of five days. We discussed insights from the adapted immersions including people’s thoughts about their priorities, facilitated them to brainstorm, develop and try out local solutions that could encourage positive behaviour change related to accessing malaria treatment and prevention.

Through the PDD process, we were very encouraged by community members and health providers’ enthusiasm to promote positive behaviours in their communities. Currently, the behaviour change solutions that they co-designed continue to be trialed, promoted and refined by the community members and health providers. We hope this study as well as the groups’ local solutions can give valuable feedback to improving malaria programs in the future.

We hope to be able to share some of the study's outputs in the next few months.