Human Resources Development

In most countries with endemic malaria, there is a shortage of people knowledgeable in its epidemiology and in the planning and management of its control. In many, the peripheral health services are unequal to the task of diagnosis and correct treatment. An important element of the Global Strategy is therefore to build up malaria training capacity as part of the effort to equip all levels of the health services with the competence to control communicable diseases.

For malaria specifically, the object of training within the Global Strategy is to increase competence in disease management, epidemiology, the appropriate use of vector control, and the prevention and control of epidemics. This entails not only instruction in new skills for general health service and malaria service staff, but also some redirection, away from certain ingrained practices.

Other groups who need appropriate education include those who sell drugs officially or unofficially, private practitioners of traditional and modern medicine, and people in such fields as economic and development planning, agriculture and education. At the community level, for example in women's groups and among schoolchildren, education enhances awareness and skills, empowering people to be active partners in malaria control.

Training should be task based, problem solving, practical and interactive. Skills to be emphasized include the ability to teach others at more basic levels, including the community. Listening and learning in the community are crucial to interactive training. Retraining is essential to reorient workers who have previously focused on eradication, and in service training enhances skills while helping workers to adjust their activities to changing epidemiological situations.

Training itself is only one part of the capacity building and programme sustaining process. Another, vital part is the financing of training. The costs include not only training centres and initial courses but in-service follow-up and adequate equipment and other support so that people can progressively apply what they have learned. In-service follow-up puts emphasis on the educative role of supervisors, which is cost effective but not cost free. Strong financial commitment at high level is needed to underpin training and ensure that it is sustained.

Trainers should include a national core group to conduct and coordinate training in accordance with national malaria policy, people skilled in malariology and educational methodologies, specialists such as entomologists, and people in related sectors such as agriculture, engineering and health education.

Training should take place at levels relevant to the tasks that are required, whether at international courses or in rural health centres. As a general guide, the training environment should reflect working conditions as closely as possible.

Malaria control tasks should guide curriculum content. The skills for which training is needed include epidemiology, operational research, financing, management, planning, monitoring, evaluating and replanning. Malaria programme staff must also be able to work effectively within community social structures to promote health and invite partnership.

There is a particular need to strengthen, and in many cases to restore, training on malaria in pre-service curricula for schools of medicine, nursing, pharmacy and laboratory technology. These curricula should be periodically reviewed to ensure that training is up to date in relation to norms and government policies on the management and control of malarial disease.