How can Complexity and Systems Thinking end Malaria?

November 4, 2013

     By Duncan Green     

This is complexity week on the blog, pegged to the launch of Ben Ramalingam’s big new book ‘Aid on the Edge of Chaos’ at the ODI on Wednesday (I get to be aBen Ramalingam cover discussant – maximum airtime for least preparation. Result.)

So let’s start with a taster from the book that works nicely as a riposte to all those people who say (sometimes with justification, I admit) that banging on about complexity is just a lot of intellectual self-indulgence (sometimes they’re not so polite). We know what works, why complicate things? Hmmm, read on:

‘Kenya’s Mwea region is especially prone to malaria because it is an important rice-growing region, and large paddies provide an ideal breeding ground and habitat for mosquitoes. The application of insecticides and anti-malarial drugs has been widespread, but there has been a marked rise in resistance among both mosquitoes and the parasites themselves.

A multidisciplinary team developed and launched an eco-health project, employing and training community members as local researchers, whose first task was to conduct interviews across four villages in the region, to give a first view of the malaria ‘system’ from the perspective of those most affected by it.

The factors involved were almost dizzyingly large in number—from history, to social background, to political conflicts. A subsequent evaluation of the programme referred to this as an admirable feat of analysis.

Using a systems analysis approach that placed malaria in the wider ecological context was a critical part of the programme design:

malaria‘The approach can be compared to using a camera with a zoom lens. The zoom brings the problem into sharp focus – in this case, a mosquito infecting a person with malaria. As the lens pulls back, other elements are brought into the picture: poverty in the villages; farming practices in the rice fields . . . this ‘wide-angle’ view helps researchers to determine the reasons behind the malaria statistics and to develop possible interventions. ‘

Particularly noteworthy causative factors were the unforeseen effects of a local resistance movement, whereby farmers had decided to exert local control on irrigation systems, overturning a system of national government control that dated back to the colonial era and was associated with continued impoverishment.

However, the change led to ‘agricultural chaos in which farmers plant when and where they want’, pushing up both the mosquito population and the number of malaria cases. Mwea also supports a substantial cattle population, which provides an alternative blood source for mosquitoes: the village with the highest number of mosquitoes per household also had the highest cattle population and the lowest malaria prevalence.

A range of solutions were developed and tested, all of which saw a shift away from the ineffective standard medical responses. For example, better coordination of farmers led to a reduction of the paddy flooding time. Rice planting was alternated with soya, a dry crop, which both reduced the mosquito population and improved villagers’ diets.

Other strategies included the maintenance of cattle populations as bait; the introduction of naturally occurring bacteria to kill mosquito larvae at peak breeding times; planting mosquito-repelling plants around houses; and ensuring vulnerable groups like children and pregnant women always used bednets at night.

A subsequent assessment of the ‘integrated malaria management approach’ found that cases of malaria at the community hospital had declined steadily,prevent-malaria from 40 per cent at the start of the project in 2000 to less than 10 per cent in 2004 and zero in 2007, and that the single biggest element of the community-based malaria control strategies consisted of ‘environmental management’ approaches. Through the System-wide Initiative on Malaria and Agriculture, the Mwea experience is now being disseminated across the country, with the goal of finding ways to reduce malaria while improving people’s health and productivity.’

Tomorrow ODI’s Harry Jones will take stock of where we’ve got to on complexity and development.

November 4, 2013
Duncan Green