Are we interconnected? A qualitative study on the role and perception of different actors on malaria social behaviour change interventions in rural Mozambique

BACKGROUND: Interconnecting institutions (health and education sector) and community (through a network of community structures) in social and behaviour change (SBC) activities can add value in an effort for malaria prevention towards a long-term objective of elimination. This approach has been implemented since 2011 in some rural districts of Mozambique. The objective of this study is to describe the perceptions of community and institutional actors on malaria prevention interventions in rural Mozambique. METHODS: A descriptive qualitative study with a constructivist research paradigm was conducted in October 2018 in two rural districts of Zambezia Province with high malaria burden in Mozambique. Key-informant sampling was used to select the study participants from different actors and layers: malaria community volunteers, health professionals, non-governmental actors, and education professionals. In-depth interviews (IDIs) and focus group discussions (FGDs) were used to explore the perceptions of these actors. Classic content analysis looking for themes and semantics was used, and saturation guided the sample size recruitment. RESULTS: A total of 23 institutional actor IDIs took place, and 8 FGDs were held. Four themes emerged from the content analysis: (1) organizational and functional aspects; (2) knowledge about malaria; (3) perception of institutional actors on SBC and community involvement; and, (4) perception of institutional actors on the coordination and leadership on SBC malaria interventions. Community structures were well organized, linked to the health sector and operational, with good knowledge of malaria prevention. Education sector (school teachers) links with the health sector were in some cases good, and in other cases, non-existent. The importance of SBC interventions for malaria control was recognized by health actors, although the activities are delegated to non-governmental institutions. Domestic budgetary allocation constraints, quality of intervention and lack of SBC standard indicators were also identified by health actors as aspects for improvement. CONCLUSIONS: Community structures, volunteers and primary school teachers have good knowledge on malaria prevention and regularly sensitize community members and students. Institutional health actors and partners recognize their role on malaria prevention activities, however, more interconnection is needed at different levels.