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There's Gold in Social and Behavior Change Human-centered design research around malaria care-seeking behaviors in gold mining communities of Guyana

This photo essay is the first installment in a series summarizing the work conducted by Breakthrough ACTION Guyana. View the second installment here.

In Guyana, 70% of all recorded cases of malaria are found in just four of the country’s regions: 1, 7, 8, and 9. Of those cases, 70% are found among men and 43% among Ameridian throughout the country's hinterlands.

The geographically dispersed and extremely hard-to-reach nature of these regions results in difficulty accessing public health services, as well as a substantial gap in the provision of malaria diagnostic and treatment services.

To better understand the connection between malaria and gold mining communities in Guyana, Breakthrough ACTION, in collaboration with the Ministry of Public Health (MoPH), Pan American Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are working in Regions 7 and 8 to improve malaria outcomes among mining communities.

HOW MIGHT WE IMPROVE MALARIA OUTCOMES AMONG MINING COMMUNITIES IN REGIONS 7 AND 8?

Map of Guyana showcasing Regions 7 and 8.

The Guyana Ministry of Public Health (MoPH), Pan American Health Organization (PAHO), and Global Fund to Fight AIDS, Tuberculosis and Malaria are currently working together to introduce rapid diagnostic tests (RDTs) and treatment for malaria in and around mining communities in Regions 1, 7, 8, and 9.

Piloted in Region 8 and now scaled to other endemic regions, the RDT program trains workers in mining camps and surrounding areas as volunteer testers who perform free RDT testing and provide appropriate treatment.

This RDT program brings care closer to distant communities to decentralize healthcare, and enables the health system to catch malaria cases more quickly.

To support the success of the RDT testing program, Breakthrough ACTION Guyana is working hand in hand with the MoPH to implement Social Behavior Change (SBC) in the mining camps and surrounding communities in endemic regions of Guyana. We do this through two main activities: co-creating solutions to encourage miners to access malaria testing and treatment services with key stakeholders; and assessing and strengthening the SBC capacity of the MoPH.

Guided by Breakthrough ACTION's Social and Behavior Change (SBC) Flow Chart, Breakthrough ACTION Guyana and the MoPH are working together to understand the experiences and perspectives surrounding malaria in mining communities in Regions 7 and 8.

Breakthrough ACTION’s SBC design process integrates research, behavioral science and economics, human-centered design (HCD), strategic communication, and community capacity strengthening into a cohesive, flexible approach. In Guyana, Breakthrough ACTION uses HCD, strategic communication, and community capacity strengthening.

There are three key phases of the process: Define, Design and Test, and Apply. These phases are linked by transition stages during which the strategy is developed and refined.

A LEARNING-BY DOING APPROACH

Difficult and challenging situations require creative approaches to reframe and tackle problems. Breakthrough ACTION’s approach allows us to immerse ourselves in the context and shoes of our audience, which is vital to developing potential solutions.

The immersive nature of this approach allows us to deeply understand the experiences, challenges, and perspectives of the people who are ultimately affected by malaria in Guyana. This, in turn, provides us with valuable first-hand insights from which we can make informed and impactful decisions throughout the design process.

Adopting a “learning-by-doing” methodology, Breakthrough ACTION Guyana helped MoPH staff learn and implement an SBC approach to understand the malaria situation in Regions 7 and 8.

MoPH staff were engaged in the research from the beginning and helped shape the Define phase. Breakthrough ACTION Guyana worked with the MoPH to conduct field visits to Region 7 and 8, which was a vital component in identifying potential research sites.

An intent workshop was carried out with key stakeholders from the MoPH, United States Agency for International Development, Breakthrough ACTION, and other partner organizations to determine the parameters of the project and align expectations.

Afterwards, participants attend a capacity strengthening workshop over several days to build their capacity in qualitative research skills and techniques by learning more about research ethics, the elements of a good interview, how to conduct observations, empathetic listening, and documentation tips.

Discovery Research and initial findings

Two research teams consisting of Breakthrough ACTION and MoPH Vector Control Services and Public Relations/Health Promotion Unit staff set out to learn more about the context and malaria experiences of mining communities in Regions 7 and 8.

The research team spoke with a total of 108 miners, camp managers, trained malaria testers, regional administration, and hospital staff throughout Regions 7 and 8. Here is what we found.

CROSSING BORDERS TO JOIN GOLD MINING COMMUNITIES

Gold miners travel throughout Guyana, and even come from bordering countries, in search of employment in mining communities. Miners look to support themselves and their families. Compared to other industries, the mining industry allows employees to quickly earn a good income.

Daily Life in Mining Communities

A typical work day for miners in Regions 7 and 8 is 12 hours long. Many miners work three weeks at a time with two weeks of rest.

Their tasks are physically demanding—from managing jet sprays to operating large machines.

Most miners live in camps on the same campus as the mining site.

Depending on the camp’s formality, size, and management, living quarters can range from hammocks underneath makeshift tarp tents to cabin style rooms.

In some communities, there is just one mining camp on its own, while in others, there are clusters of gold mining dredges together.

In many camps, miners sleep in the same tents that serve as the common areas of living quarters.

Most of the individuals living in mining camps we visited use mosquito nets distributed by Vector Control Services staff, or acquired by the miner themselves.

In formal camps, there are support staff, including cooks who prepare all the meals.

Some mining communities and camps have trained malaria testers, while other communities are located within walking or driving distance of health clinics and pharmacies.

However, not all of the miners know who is trained to provide malaria treatment or where health facilities are located.

For Miners, Getting Malaria Leads to Very Real Impacts on Day-to- Day Productivity

Every day a miner is sick and unable to work means less money being earned. Getting malaria and not using proper treatment can lead to further relapses and risk of infection for fellow miners.

It is, therefore, crucial to ensure there is adequate malaria prevention, that tests are performed to confirm the disease, and that miners take the necessary treatment to cure it.

Analyzing Initial Findings

Following the Discovery research, the two teams came together to collectively analyze the data, create data points from the findings, and organize them to find overlaps and connections in the findings.

After grouping similar data points, we created insights statements, which are a one-sentence summary of a collection of data points that reframe our understanding of the context to highlight an opportunity for change.

The research team working together to create insights statements.

OUR FINDINGS LED TO THE CREATION OF 11 INSIGHTS

Insights are statements that combine multiple pieces of information. They encourage us to re-perceive a situation and encourage an opportunity of action.

Emerging insights were presented to key stakeholders during a validation workshop.

Breakthrough ACTION Guyana Senior Program Manager, Sean Wilson giving remarks at the Insights Validation Workshop in Georgetown, Guyana. Also in attendance were Dr. Karen Cummings, Junior Minister of Public Health, Perry Holloway, US Ambassador to Guyana, and Dr. Horace Cox, Director of the Ministry of Public Health Vector Control Services Unit.
“THE INTENTION IS THAT WITH TECHNICAL AND MEDICAL EXPERTS, AND MOST IMPORTANTLY THE PARTICIPATION AND COLLABORATION OF THE COMMUNITIES AFFECTED BY MALARIA, WE CAN CREATE SOLUTIONS TO BARRIERS THAT WEAKEN MALARIA PREVENTION EFFORTS AND DELAY TESTING AND TREATMENT" - MR. PERRY HOLLOWAY, US AMBASSADOR TO GUYANA
“IT IS IMPORTANT THAT WE DO AN ASSESSMENT TO UNDERSTAND THE GAPS IN THESE COMPONENTS OF THE INDIVIDUAL OR PATIENT THAT WILL INFLUENCE THE BEHAVIOUR AND SUBSEQUENTLY USE THIS INFORMATION TO GUIDE THE DEVELOPMENT OF STRATEGIES THAT WILL TARGET IDENTIFIED ISSUES… IT IS IMPORTANT TO KNOW THAT THE LIMITED POOL OF ANTIMALARIALS AVAILABLE TO TREAT PATIENTS MUST BE PROPERLY MANAGED BY THE HEALTHCARE PROVIDER AND PATIENT,” - DR. KAREN CUMMINGS, JUNIOR MINISTER OF PUBLIC HEALTH
In the first row (from left to right): David Williams, Shirley Yan, Dr. Joann Simpson, Shabana Bruce, Charmaine Semple, Nikishaw Khan. Second row (left to right): Dr. Michael Marks, Rohan Doherty, Natalie Griffith, Royan Teixeira, Sean Wilson, Doug Storey. Third row: Dr. Quacy Grant.

Design and TEST PROMISING SOLUTIONS

In March of 2019, Breakthrough ACTION and the MoPH conducted the Design and Test phase of the project, during which stakeholders co-designed, tested and iterated potential solutions together with mining camps and communities. These prototypes are based on the insights generated from the Define stage of the project.

The Design and Test Phase builds on the opportunities and design strategy identified during the Define Phase to generate ideas and test early prototypes with target audiences. This is an iterative and fast-paced process for developing and testing multiple designs to address the opportunity areas. Key activities will be implemented with the MoPH and Public Relations/Health Promotion Unit staff.

For More information...

More information about key insights is available in the Breakthrough ACTION Guyana Insights Report, which provides an overview of all activities completed during the Define Phase. Key findings are consolidated and presented alongside opportunities to take forward to the Design and Test Phase.

Acknowledgements

We would like to acknowledge our MoPH partners in Guyana, in particular, Dr. Horace Cox, Dr. Neil Trotman, Dr. Helen Imhoff, Dr. Michael Marks, Dr. Dexter Browne, Mr. David Williams, Ms. Charmaine Semple, Ms. Nathalie Griffith and Mr. Royan Teixeira from Vector Control Services and Mr. Terrence Esseboom, Ms. Nickishaw Khan and Ms. Shivhana Bruce from the PR/HPU. We would also like to express our thanks to Dr. Quacy Grant.

This Spark page is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Breakthrough ACTION Cooperative Agreement #AID-OAA-A-17-00017. Breakthrough ACTION is based at Johns Hopkins Center for Communication Programs (CCP). The contents of this presentation do not necessarily reflect the views of USAID, the United States Government, or Johns Hopkins University.
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Lyndsey Mitchum
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