The Presbyterian Church (USA), as a provider of health services in Africa for over 100 years, recognizes both the toll of malaria in African communities and the church's unique ability to respond with effective, affordable malaria prevention activities. Beginning in 1998, PC(USA) facilitated the development of community-based malaria prevention and education projects which are implemented through local Christian congregations. The "NetWorkers" malaria prevention program began at two pilot sites, in Malawi and Cameroon, and has expanded to now include 15 projects in eight nations.

While each project is independent and allowed to shape itself to the specific needs of the community, each is an example of a congregational-based community health project, combining health education and treatment with Christian mission. Malaria prevention is a natural fit for the congregational-based community project model, because it is a health problem which impacts the entire population of a community, and it can be addressed with easy-to-do, low-cost methods that can be carried out by all members of the community..

The malaria prevention activities of the PC(USA) projects are typically implemented by NetWorker committees made up of members of the Women’s Guilds of PC(USA) partner congregations in malaria-endemic areas. Women in the communities, who are already responsible for the health of their families and organized within the church structure, are easily mobilized to put their faith into action, carrying out malaria prevention activities as a demonstrable show of their Christian concern for their neighbors. These activities include surveying the community, conducting malaria prevention education programs, selling mosquito nets, facilitating insecticide-dipping and monitoring and evaluation. Training in all facets of the NetWorkers program and technical assistance are provided to the church women by PC(USA) funding, PC(USA) health consultants or medical missionary personnel.

The primary strategy carried out by the NetWorkers project is the provision of insecticide-treated mosquito nets, which have been shown to reduce rates of malaria infection by 65% and reduce mortality in children under five by 30%. Nets are made available through the NetWorkers committees at subsidized prices, based on what the committee women determine is locally affordable. An attempt is made to build a small profit into the price of the nets, which goes back into the project to purchase more nets and insecticide. The women also manage an in-kind system to provide nets to persons with no cash resources. By structuring the provision of nets in this manner, the women who implement the project develop useful business management skills and the long-term sustainability of the project is increased.

As a faith-based organization with a long history of effective health ministry in underserved areas of Africa, PC(USA) has seen the NetWorkers projects welcomed and supported. The NetWorkers projects are established by PC(USA) at the invitation of the church’s partner institutions in the project areas. Local control at each project site has fostered a sense of ownership which contributes to the acceptance and efficacy of the projects. With its combined outreach of health care and Christian concern, and its broad reach into poor and often isolated areas, the NetWorkers program demonstrates the care of the church for the whole person, physically and spiritually, and the priority the church places on providing care for the poor.

When the Presbyterian Church began to develop congregation-based community malaria prevention projects, they recognized that U.S. Presbyterian women were particularly well-placed for the role of supporting overseas projects. They had both a natural link with their sister organizations in our partner churches and a tradition of active support for international missions. The NetWorkers project was presented to Presbyterian women in 1999 as an opportunity to protect the health of families by providing them with the simple, inexpensive safeguard of an insecticide-treated mosquito net. Educational materials sent to U.S. churches emphasized the terrible death toll of malaria on children. The International Health Ministries Office of PC(USA) and the denomination’s women’s program office strategized together on how to build and maintain support for the NetWorkers projects in U.S. congregations.

Presbyterian women in the congregations were invited to sew mosquito nets from an easy-to-assemble kit. In 1999, women representing 36 Presbyterian congregations sewed 500 nets. The nets became a visible symbol of malaria awareness and the commitment of women in the U.S. to help save the lives of children in Africa. As more women sewed nets, more congregations learned about this malaria prevention effort and more individuals contributed to the project. By the fall of 2001, three years since the first NetWorker projects were developed in Malawi and Cameroon, approximately $300,000 has been contributed to the NetWorker program, and Presbyterian women have sewn over 5,000 nets.

In the fall of 2000, the World Health Organization encouraged the Presbyterian Church to facilitate the involvement of the faith-based community in the Massive Effort to reduce diseases of poverty, the movement it is promoting at the urging of many of the world's governments. We saw this as a unique opportunity to coordinate the efforts of other denominations toward the common goal of reducing the health burden of malaria among the neediest of God’s people. By working together, people of faith can be credible advocates for increased government support of malaria prevention activities and for cancellation of the global debt burden in order to release resources for malaria prevention.

An ecumenical effort is now taking shape as the Christian NetWorkers Coalition, partnering several Christian denominations to work together in support of the goals of WHO’s “Roll Back Malaria” campaign. PC(USA) and the Reformed Church in America are developing two pilot projects targeting pregnant women in Malawi. These Christian NetWorkers Coalition Safe Motherhood Projects will provide malaria prevention education and insecticide-treated mosquito nets to pregnant women and increase the utilization of intermittent presumptive treatment by pregnant women. Implementation of the projects will follow the congregational-based community model of the other NetWorkers projects. Strategies for building support within U.S. Presbyterian congregations for the ecumenical Safe Motherhood Project will be modeled after the participation of Presbyterian Women in the NetWorkers projects. Each denomination will formulate their own strategies for engaging their congregations.

To introduce the concept of an ecumenical project in support of Massive Effort, a Mother’s Day appeal was developed which allowed individuals to make a donation of $10 or more to the NetWorkers Safe Motherhood Project. This appeal asked church members to honor their own mothers by helping to provide malaria protection for expectant mothers in Malawi. A special Mother’s Day card was created for this appeal. In a small pilot project this year, Presbyterian Women ordered over 3,000 cards, and donations far exceeded expectations. This project will be repeated and expanded next year, with the participation of ecumenical partners in the NetWorkers Safe Motherhood Project.

Recognition by the U.S. government of the effectiveness and efficiency of the health projects was demonstrated when funding through the U.S. Centers for Disease Control became available for malaria prevention work by ecumenical groups. A proposal by PC(USA) and Reformed Church in America seeking CDC funding for the Christian NetWorkers Coalition Safe Motherhood Project has been approved. The Christian NetWorkers Coalition projects will facilitate grass-roots involvement by providing a framework for community learning and the implementation of practices that empower communities to protect the health of their members.

This is a challenge whose many facets were explored throughout the CCIH conference. Other points highlighted which addressed the rich experiences of others in the area of malaria control included:

•    The fundamental need for the church to raise awareness in the North that malaria is still a major health problem for much of the world.

•    While the reach of the church is broad in some areas, there is a continual need to find more points of entry into communities so that more people can be reached with preventive measures.

•    Coalitions and partnerships need to be developed between the church, public and private sectors and governments, which would help focus political will and use collective resources to combat malaria.

•    In places where malaria is a common health risk, steps must be taken to identify what is needed to effectively address local malaria problems and then examine what resources exist within the church and community to meet those needs. Advocacy regarding access to additional resources can happen through the strengthening of partnerships between the church, the local community and other agencies.

•    The Church must become more actively represented in government policy forums whose outcomes affect the health and well-being of the poor, marginalized and disenfranchised to the world.

•    CCIH should assist in the coordination of a South-South, South-North and North-South sharing experience by creating an e-space where such exchanges can occur.