Consumers – Brands & Advertising · Editorial

By Moakanyi Magazine · June 2026

A malaria programme can have the right insecticide, the right timing and the right teams, and still fail at the doorstep. In April 2024, health officials reported a malaria spike as some communities refused indoor residual spraying, with cultural beliefs and misinformation hampering control.

The gap here is not technical but social. Indoor residual spraying works only when households accept it, and the reported refusals turned a solvable health problem into a spreading one. The constraint sat in trust, not in supply, which is the kind of failure no procurement budget can fix on its own.

The Gap: A Tool That Needs Consent

Indoor residual spraying treats the inside walls of homes so that mosquitoes resting there are killed before they can transmit malaria. Its coverage is the whole point: protection depends on a high enough share of households being sprayed to break transmission across an area, not merely to shield one home. Below that threshold the method weakens sharply, because the mosquito population recovers in the unsprayed gaps and moves between them.

That is why the April 2024 refusals registered as a spike rather than a local inconvenience. A control method that depends on near-universal consent is fragile to exactly the cultural beliefs and misinformation the officials described, and a cluster of refusals in one area can undo the protection of the households around it. The disease does not respect the boundary between a willing home and a reluctant one, so a programme that hits its supply targets can still miss its health targets.

This is the same logic that governs a vaccination campaign or any intervention with a coverage threshold. The value is non-linear: the last households are often the hardest to reach and the most consequential, because it is in the final gaps that transmission persists. A programme can be ninety percent of the way to its target and still fail, since the refusing minority is precisely the reservoir the mosquito population needs to rebuild. Treating those final refusals as a rounding error rather than the decisive constraint is how a well-supplied campaign quietly loses the season.

A spray that protects a community only works if the community lets it in.

The Lesson: Communication Is Infrastructure

When misinformation can reverse a public-health gain, the messaging around an intervention becomes as load-bearing as the intervention itself. The reported spike is a reminder that trust is a form of infrastructure, and that programmes built on entering people's homes have to be built on consent earned in advance rather than assumed on arrival. The cost of rebuilding that trust after a refusal is far higher than the cost of securing it before the spray teams arrive.

For the brands and institutions that communicate health programmes in Botswana, the implication is concrete. Reaching coverage targets depends on countering specific beliefs and specific false claims in the affected communities, working through the local voices households already trust, not on broadcasting generic assurances over them. Generic reassurance does not move a household that has heard a specific rumour; a credible local answer to that exact rumour might, which makes audience-level message design a public-health tool in its own right.

Where a programme enters the home, communication is not outreach but infrastructure.

There is a budgeting implication health planners and their communication partners cannot duck. The line items that fund insecticide, vehicles and spray teams are visible and easy to defend; the line item that funds sustained, locally credible engagement is softer and usually first to be trimmed. Yet the April 2024 experience suggests the soft line item is the one that determines whether the hard ones deliver. Under-resourcing the conversation does not save money so much as quietly waste the spending it sits beside, since a refused spray is a paid-for spray that protects no one.

The April 2024 malaria spike is a small case with a wide lesson. The hardest part of a public-health campaign is often not the science but the consent, and any programme that funds the spray while underfunding the conversation can lose the gains delivered by the first to the failures of the second. In communities where the intervention crosses the threshold of the home, the communication strategy is not a supporting line item; it is the programme.

Sources: allAfrica