Strategic Roles for Behaviour Change Communication in a Changing Malaria Landscape

This commentary, which appeared in the Malaria Journal, seeks to highlight the benefits and value for money that strategic behaviour change communication (BCC) brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change.

As stated in the article, strong evidence suggests that quality strategic BCC can improve malaria prevention and treatment behaviours. Specifically, BCC increases the likelihood of a good return on investment for malaria programmes as it helps to overcome behavioural barriers related to bed-net use, malaria treatment, malaria diagnosis, indoor residual spraying, and preventative treatment for pregnant women by ensuring that these commodities are accessed and then used appropriately at the right time.

The article makes the point that even in areas where rates of malaria are declining, BBC continues to play an important role through very focused interventions. BCC will need to reach populations who remain at risk e.g. mobile populations who travel to endemic areas, and to facilitate identification of people with asymptomatic infections and their compliance with treatment by convincing them that testing and treatment will help them as well as their communities. BCC is also important for informing communities of the optimal timing of malaria control interventions in setting where malaria is declining.

Although evidence for malaria BCC effectiveness is growing, more rigorous evaluations and research are needed to see what strategies work most effectively in different settings and to show evidence of impact. This is especially the case as transmission dynamics change. Research is also essential for planning of evidence-based, strategic behaviour change communication interventions. As stated in the article, "additional data is needed on the effectiveness of BCC for malaria. Research will help to adapt messages and approaches to reduce audience fatigue and to promote new interventions. Malaria behaviours are not static, they change in response to new policies, interventions and messages." Research will also help to understand how perceptions and behaviours change over time, a key to successful malaria elimination. The article suggests, for example, periodic national cross-sectional household surveys, that "can provide the much-needed data on determinants of malaria behaviours, track the impact of BCC efforts, solidify and inform the evidence base, and allow us to adapt efforts to respond to a changing malaria environment."

The article concludes that by "supporting the use of BCC and research on its effectiveness, donors can be assured of a much stronger return on their investments in malaria control. If in addition to being widely available, those commodities are used properly and consistently, control or elimination of malaria becomes a more attainable goal."