Society for Medical Anthropology
Volunteered - Oral Presentation Session
Community engagement (CE) is vital to malaria control and elimination but remains a far from settled concept. Haiti and the Dominican Republic (DR), which share the Caribbean island of Hispaniola, aim to eliminate malaria by 2020. In the DR, most cases of malaria are in the capital, Santo Domingo. Concurrent to these outbreaks, a policy of decentralization transferred primary responsibility for malaria control from the national to the local level. Malaria’s changing epidemiology, the vulnerability of poor, urban populations, and the need to strengthen local capacity have generated urgent calls for CE, yet there has been no formal investigation of CE practices in this setting. This study collected interviews and observations from July 2017 to March 2019 among malaria program staff, local field teams, community members, and malaria patients in Santo Domingo. Preliminary findings suggest two key themes. First, while decentralization seeks to “empower the periphery” by recruiting community volunteers, decision-making and knowledge-production are concentrated in sites of political and scientific power, creating missed opportunities for dialogue. Second, understandings of malaria’s root cause differ between public health and community spheres. Partly to avoid appearing too political, the malaria program stays focused on the vector and parasite. In communities, however, malaria is understood to be more than biological, implicating social, economic, and infrastructural inequalities: stagnant water, healthcare obstacles, and ineffective or corrupt institutions. These results reveal a disconnect in understanding between public health agencies and targeted communities, and demonstrate that effective CE will likely require a more ground-up, politically-engaged approach.