Lifestyle – Wellness & Fitness · Editorial
By Moakanyi Magazine · June 2026
A public health campaign can be funded, staffed and scheduled, and still fail at the doorstep. Indoor spraying only protects a household that agrees to be sprayed, and a programme measured by litres of insecticide procured can look healthy on paper while leaving real gaps on the ground. In March 2023, the North West district showed what happens when that agreement breaks down.
Health officials reported rising malaria cases in the district as some residents refused indoor spraying, with climate change worsening the threat. The surge was not a failure of the tool. It was a failure of uptake, which is a harder problem to solve because it sits in households rather than in budgets.
The Gap: A Tool That Needs Permission
Indoor residual spraying is one of the more effective defences against malaria, coating the walls of a home so that mosquitoes resting there after feeding pick up a lethal dose. But it works only inside homes that accept it. When some residents in the North West refused the spray, they left openings in the coverage that the mosquito does not need a map to find. Malaria control depends on suppressing transmission across a whole community, so one unsprayed cluster of houses can sustain infection that spreads back into sprayed homes.
Refusal is rarely irrational from the household's point of view. Spraying can mean moving furniture, vacating rooms, tolerating odour and residue, and trusting that the chemical is safe. Where past campaigns have been poorly explained, or where trust in officials is thin, declining is a reasonable response to a request that carries visible costs and invisible benefits. This is the recurring limit of campaign-style public health: the science of the intervention can be sound while the social acceptance of it lags, and the gap between the two is where cases rise.
An intervention that needs consent is only as strong as the trust behind it.
The Multiplier: A Warming Climate
Officials linked the worsening threat to climate change, which extends the conditions under which malaria-carrying mosquitoes breed and survive. Higher temperatures and shifting rainfall lengthen the transmission season and can push the disease into areas and times of year that were previously marginal for it. A longer or wetter season widens the window of transmission, so the same level of refusal produces more cases than it would have in a cooler year.
That combination is the harder problem. Climate change raises the baseline risk while refusal lowers the coverage, and the two move in opposite directions at the worst possible time. For a district like the North West, near the wetter Okavango systems where mosquito habitat is abundant, the margin for error in coverage is already thin, and a warming climate is steadily eating into what remains of it.
When the climate raises the risk, every gap in coverage costs more.
The Lesson: From Campaign to Conversation
The North West surge suggests that the next gain in malaria control may come less from the chemistry of the spray than from the conversation around it. A campaign that treats households as targets to be covered will keep hitting the wall of refusal. One that treats them as participants to be persuaded, through local leaders, clear information and a track record of safety, has a chance of closing the gap. The cost of that engagement is real, but it is small against the cost of an outbreak that spraying could have prevented.
Botswana has run effective public health programmes before, including the HIV response that built genuine reach into communities, so the infrastructure and the institutional memory for door-to-door work clearly exist. The missing element in the North West was not capacity but consent, and consent is earned in a register that procurement and logistics cannot reach.
Coverage is decided at the door, not in the budget.
The rise in cases is a reminder that public health is not only a technical exercise. The tools work; the question is whether people accept them, and in a warming climate that question gets more expensive to leave unanswered. The honest measure of a spraying campaign is not how much was sprayed but how many doors opened, and that is a metric no budget line captures on its own.
Sources: allAfrica
