Addressing gender imbalance in malaria interventions

Civil Society in Malaria Control, Immunisation and Nutrition (ACOMIN) has stressed the need to address gender imbalance in malaria intervention and empower men and women with right knowledge, as opposed to leaving any particular gender behind.

The group said in seeking permanent solutions to the life-threatening disease, there is need to continually review strategies being employed to fight malaria, with a view to bridging gaps that undermine tireless efforts being made by government and non-state actors.

According to the World Health Organisation (WHO), one of the ways in which gender imbalance affects malaria intervention is access to health care services. In some parts of Nigeria, women have to ask for their husband’s permission to access treatment for themselves and/or their children. In many Nigerian communities, due to cultural and religious boundaries, male health workers cannot attend to female patients, especially when these patients are married women.

The latest World Malaria Report showed there were 241 million cases of malaria in 2020 compared to 227 million cases in 2019, while the estimated number of malaria deaths stood at 627,000 in 2020 – an increase of 69,000 deaths over the previous year.

About 80 per cent of all malaria deaths in Africa came from children between the ages of zero and five. As recently as last year, about half of the world’s population was said to be at risk of malaria, the most vulnerable groups being pregnant women and children below the age of five.

All these point to one fact: malaria, a preventable and treatable disease spread by the female anopheles mosquito, is still a leading cause of illness and death in many countries, among which is Nigeria.

Speaking at the quarterly advocacy meeting of the group, ACOMIN National Coordinator, Mr. Ayo Ipinmoye, observed that malaria can have different socioeconomic consequences for men and women, adding that with increase in malaria morbidity and mortality, it has become necessary to look into some of the existing gaps that are yet to be adequately resolved. And one major area that needs improvement in malaria intervention is gender balance.

Ipinmoye noted that the vast majority of women are not playing lead roles in this cause as economic inequities sometimes place women at a disadvantage because they lack financial resources required to access malaria services at health facilities.

He said: “Several efforts are being made to eliminate the disease. The initiatives that have been deployed to fight malaria in Nigeria include but are not limited to the provision of free Long-Lasting Insecticide-treated Nets (LLINs), deployment of volunteers to carry out Interpersonal Communication at grassroots level, provision of free malaria test kits and medicines at some health facilities and community-led monitoring to ensure accountability in malaria interventions. The acceptability and use of LLINs are strongly linked to culturally accepted sleeping patterns, in which gender plays an important role. In some instances, young children sleep with their mother and are therefore protected by her bed net if she has one. Alternatively, if a household only has one bed net, priority may be given to the male head of the household as he is often considered the primary breadwinner. In other contexts, men have very little access to ITNs if they predominantly sleep outside.”

According to him, “It has been discovered that the workload of women significantly increased whenever a member of their households falls ill. One study found that women performed 64 per cent of all tasks normally undertaken by the sick person. The study pointed out that although the disease burden was greatest among adult males, the indirect economic burden of the disease was greater for women. ACOMIN also observed these gender related issues in our interventions with communities. And taking these issues into consideration has helped us achieve more effective results. Women need their husbands’ permission to attend health facilities, even in instances where the child is severely ill. Before the husband could be located to give the approval that the child be treated, the situation has gotten out of hand. The child dies.

“Female community members would not access services from facilities where there are no female service providers, because the culture forbids them from accepting services from a male. Thus in instances where medicines and other needed equipment have been provided by Global Fund, Government and other partners, the lack of female health workers alone would hinder women from seeking and accepting much needed care.

“As a response to the above, we have been advocating for the deployment of female staff to the facilities. And ACOMIN has been successfully engaging the LGAs and Communities to provide female health workers, as full time staff and in many cases, as Volunteers. Where this has been done, it has resulted in dramatic increases in uptake of malaria and other health care services.

In many instances, females do not access services for lack of toilet facilities. Whilst the men can and do use nearby bushes and other spaces to ease themselves, this option is not open to women.”

Ipinmoye recommended that more women should get involved in malaria intervention at all levels while the Government and Partners should identify the gender-related barriers that exist in their coverage areas and take steps to mitigate their effect.

“Since women bear the brunt of malaria directly (by falling ill from malaria or becoming more vulnerable to it when pregnant) or indirectly (by having to care for family members who fall ill from malaria), adolescent girls and women should be empowered in decision-making roles to improve the response to this preventable and treatable disease. Interventions that focus on seeking out and listening to their voices and experiences should be deployed. This way, they will be engaged in creating and delivering solutions to tackle malaria,” he added.