Steadfast Focus: How Nothing is Stopping Guinea’s Fourth Malaria Bed Net Campaign

By Richard Reithinger, RTI International

Warehouse in Conakry where bed nets were stored prior to distribution to regions and districts. Photo Credit: Jean-Luc Taton/StopPalu+.

Since I arrived in Guinea, it has been raining — sometimes lighter, sometimes harder — non-stop. I am here to visit colleagues who through the U.S. Agency for International Development (USAID) Guinea StopPalu and StopPalu+ programs have been supporting the Ministry of Health to control malaria in the country for the past 10 years.

In these 10 years, with USAID support, Guinea has scaled-up testing for malaria and treatment of confirmed cases across health facilities and communities, expanded access to intermittent preventive therapy for pregnant women, and distributed insecticide-treated bed nets. Collectively, these efforts have paid dividends; the prevalence of malaria in children under five years of age has decreased from 44% to less than 17% since 2012. Incredibly, Guinea achieved this progress despite the Ebola epidemic that ravaged the country and brought its health infrastructure to the brink of collapse in 2015–2017, the COVID-19 pandemic since 2020, and continued political instability.

Warehouse in Conakry where bed nets were stored prior to distribution to regions and districts by fourteen-wheelers and trucks. Photo Credit: Jean-Luc Taton/StopPalu+

The latest effort to drive malaria down even further is a national insecticide-treated bed net distribution campaign — the fourth of its kind in Guinea after others in 2013, 2016, and 2019. Widely considered one of the most effective tools for reducing malaria transmission, bed nets serve as an essential first line of defense. They serve both as a physical barrier from mosquitoes and are also covered with insecticide that kills mosquitoes, and it’s estimated that the use of bed nets has majorly contributed to the reduction of malaria cases observed in Africa since 2001.

This new campaign represents an immense country-led, nine-month-long, all-hands-on-deck collaborative effort between the Ministry of Health and National Malaria Control Program, various partners such as the President’s Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Against Malaria Foundation, as well as district administrations and — of course — communities.

Reaching the last mile: delivering bed nets by boat to Kapken island, an 18-hour journey from the mainland. Photo Credit: Jean-Luc Taton/StopPalu+.

With a population of 14.1 million people, Guinea is currently in the last stages of distributing 9.4 million insecticide-treated nets so that every household has one net for every two people. This required holding hundreds of planning meetings at the national level and across 38 districts throughout the country, enumerating 2.4 million households, including by piloting a new digital platform, training almost 16,000 household enumerators, bed net distributors and supervisors, renting more than 500 trucks to distribute the nets from national to regional warehouses and then to district and community distribution sites, and conducting a community mobilization and sensitization campaign using radio, plays, and town criers.

However, even a carefully and collaboratively planned effort like this can encounter countless obstacles. The team conducting the campaign had to face almost daily challenges: delays in bed net shipments that result in delays of all other downstream activities; traversing expansive marshes by foot and steering small boats in the open sea to deliver bed nets to remote communities and households; competing health campaigns such as child immunizations; a week-long strike by local banks holding up remuneration payments to campaign staff; and digging the trucks and four-wheel vehicles out of the mud on roads that have been battered by incessant rains for weeks.

The team works to dig their car out of the mud while traveling to a remote village during the rainy season. Photo Credit: Aissata Fofana/StopPalu+

Navigating such curveballs requires incredible dedication and commitment, creativity and solutions-oriented thinking, diplomacy, and — perhaps most importantly — dogged determination.

But as Dr. Keita Sitan, StopPalu+ Senior Technical Manager says,

“It’s absolutely worth it. We will not stop the campaign until every household is covered. With malaria peak transmission season around the corner, the population at risk of infection — particularly pregnant women and children under five years of age — needs to be protected from the bites of the malaria mosquito vectors. Not protecting them leaves them extremely vulnerable, because not only is their health impacted if they do get malaria, but also their household’s livelihood.”

“It’s all worth it.” Mother in Forécariah with her children and their bed net. Photo Credit: Patrick Adams/RTI International.

It is this unwavering determination that will propel the StopPalu+ team to achieve its goal to deliver the last bed nets over the last four weeks of the campaign, and help Guinea continue its remarkable progress in its fight against malaria.

Learn more about Guinea’s 2022 national malaria bed net campaign.

Funded by USAID Guinea under the U.S. President’s Malaria Initiative, StopPalu+ is implemented by RTI International, in collaboration with Medical Care Development, Jhpiego, Project C.U.R.E., Centre Africain de Formation pour le Développement, Club des Amis du Monde, Comité des Jeunes Mon Avenir D’abord, Initiatives et Actions pour l’Amélioration de la Santé des Populations, and Solidarité Guinéenne pour le Dévelopement.