A mother and her two children at the market in Luangwa, Zambia, on the day after World Malaria Day. Photo: PATH/Cristina Herdman. |
Counting malaria out in Zambia and Ethiopia
Saturday, April 25, 2009, marked the second annual World Malaria Day. PATH’s staff and our partners provided on-the-ground coverage of activities in Zambia and Ethiopia.
Pamodzi
Posted by Cristina Herdman, MACEPA Senior Communications Officer
April 28, 2009, Lusaka, Zambia—Ending our World Malaria diary with a post called “pamodzi” seemed fitting. It is the Nyanja word for “together,” a word with special significance in Zambia and particular importance to the fight against malaria.
We’ve spent the last couple of days since returning to Lusaka meeting with colleagues and partners to tie up loose ends and clarify next steps in our work together. The National Malaria Control Centre was a bit quiet on Monday—many took the day off after an intense period of preparation around World Malaria Day. But by today people were back, and there was quite a lot of talk and reflection on events over the weekend.
Countries working together to reach global targets
In my last conversations with my colleagues Dr. Mutombo and Dr. Maket, they both seemed to share the belief that Zambia is unique in its capacities, commitment, and progress in stopping malaria. As Dr. Mutombo pointed out, Zambia is not alone in its progress—Ethiopia, Rwanda, and Eritrea also have made impressive advances in reducing the health impact of malaria.
While individual country successes such as these are cause for hope and celebration, national success in isolation has limited use in this age of malaria elimination. To reach the 2010 Roll Back Malaria target of universal coverage, and to attain the Millennium Development Goals of reducing child mortality, improving maternal and child health, and combating malaria, a united effort in Africa is needed. Dr. Maket put it well: “Countries together need to consolidate their experience, lessons learned, and commitments to neighbors in order to see real progress on the scale of these global expectations.”
Sign outside of Katete District Health Office. The Millennium Development Goals resonate even in some of the furthest reaches of Zambia. Photo: PATH/Cristina Herdman.
I also was able to chat today with Dr. Elizabeth Chizema, the coordinator of Zambia’s National Malaria Control Programme. She smiled broadly when reflecting on activities in Zambia in recent days. When asked about the future prospects for malaria elimination in Zambia, her answer was plain: “The success seen today in Zambia is a reflection of strong leadership and coordination within the Ministry of Health and robust commitment at the provincial and district levels. But as was witnessed in Katete, the greatest indicator of our current and future success is the commitment of all the people of Zambia to work together in this effort.”
These conversations had a common theme: no single country, organization, or person can stop malaria by itself. Together, pamodzi, we can succeed in counting malaria out. Until next year…
Eleven thousand long-lasting insecticidal nets purchased by the National Malaria Control Programme and MACEPA were distributed in Katete on World Malaria Day. Photo: PATH/Cristina Herdman. |
The roots of the tree
Posted by Cristina Herdman, MACEPA Senior Communications Officer
April 28, 2009, Lusaka, Zambia—Laura and I were able to spend some time today with Richard Harrison, the director of Society for Family Health, and his colleague Cynthia Changufu, malaria program operations manager. Society for Family Health is a nongovernmental organization based in Lusaka and focused on marketing and social mobilization around some of the basics of good health: safe water, reproductive health, and malaria control. The organization has played a central role in implementing Zambia’s malaria in pregnancy program on behalf of the Ministry of Health. They do this primarily by distributing long-lasting insecticidal nets through antenatal clinics to pregnant women and children under five, having distributed some 820,000 nets last year and planning to do the same this year.
When I asked them what they viewed as challenges that lie ahead, Richard spoke of Zambia being at a crossroads in many respects. There are challenges in making sure there are adequate quantities of nets available every year. Now that high coverage has been broadly achieved, Zambia must sustain these gains because malaria resistance drops off and people become more vulnerable to the disease. We also need to make sure that people have both a realistic perception of their risk of malaria and an understanding that they can prevent themselves from getting sick, because that will increase the likelihood that they will sleep under a net every night, not just when it’s raining.
Richard and Cynthia also spoke of the need for Zambia and its partners to turn its attentions to sustaining high coverage as mass distribution on its recent scale is phased out. Zambia’s network of antenatal clinics reaches to the farthest corners of the country in a way that Richard likened to a tree’s root system, connecting to community health workers, neighborhood health committees, traditional birth attendants, and others who live in the communities where they work. As he put it, “These are the real advocates for malaria control, not us. They are incredibly important to Zambia’s success."
Success in Ethiopia, and more to come
Posted by Asefaw Getachew, MACEPA Senior Technical Advisor
April 27, 2009, Kombolcha, Ethiopia—World Malaria Day was celebrated in Kombolcha town, Ethiopia, on Saturday, April 25. The guest of honor was H.E. Dr. Kebede Worku, Federal Ministry of Health state minister. The celebration drew participants and partners from national, regional, and local levels. Malaria and Trachoma (MalTra) Week was also launched on World Malaria Day.
The day was successfully marked and accompanied by many activities, including a music show, sports competitions, demonstrations of how to properly hang mosquito nets, social mobilization games using the mobile van, and more.
Demonstrations of how to properly hang bednets were part of Ethiopia's World Malaria Day activities. Photo: Asefaw Getachew.
Many people participated in our malaria quiz competition, which tested people’s knowledge about malaria control interventions. The quiz competition showed that much work remains to be done in educating people about the proper use and maintenance of mosquito nets. Dr. Worku addressed this challenge, among others, during his speech. In the coming year, Ethiopia will work to improve mosquito net use and maintain, and replace, old nets.
We also took this opportunity to celebrate what we have accomplished in the last year. Malaria dropped from the first to the sixth cause of all outpatient hospital visits, and reported deaths attributed to malaria were reduced by 55 percent—two huge successes for us.
The community mobilization around World Malaria Day was exceptional in Kombolcha town, and many more people turned out for this year’s event than last year. The state minister renewed Ethiopia’s commitments to eliminate malaria in the country. To meet our goals, the country has deployed a huge army of 30,190 health extensions workers, and 1.6 million mosquito nets are in warehouses ready to be distributed this year. With these resources, a strong partnership, and our renewed commitments, we are looking forward to another challenging and successful year in malaria control.
World Malaria Day is here
April 25, 2009, Katete, Zambia
The stage is set
Posted by Laura Newman, MACEPA Communications Associate
A parade kicked off World Malaria Day 2009, with Minister Simbao and other invited guests marching behind a school band from Chipata, the provincial capital of Eastern Province. Photo: PATH/Laura Newman. |
April 25, 3009, Katete, Zambia—The Mphangwe Motel is one of the only places to stay in Katete, and when we sat down to eat our nshima and bream last night, we were in good company. Our restaurant was full of some of Zambia’s best and brightest malaria control experts, in town for World Malaria Day. I got into a great conversation with some folks from RAPIDS about their innovative techniques to improve net usage, while Cristina and Todd were chatting with workers from Malaria Consortium and the National Malaria Control Centre over Cokes and Mosis (Zambian beer).
We all woke up early this morning to a beautiful sunrise and drove the 12 km from the motel to the Mbinga Grounds, the site of the day’s activities. The dusty road was overflowing with cars, bicycles, and people on foot—all heading in the same direction. By the time the marching band had reached the grounds to signal the arrival of the Minister of Health, many hundreds of people had turned up.
World Malaria Day banner welcoming guests from around the country to Katete District. Photo: PATH/Todd Jennings.
This World Malaria Day seems particularly critical as a benchmark toward progress on important global targets. The Roll Back Malaria target of countries achieving universal coverage by 2010, combined with the Millennium Development Goals (read more on the United Nations website), mean that countries need to be moving quickly for success. Today was a time to take stock of progress and challenges ahead.
A number of drummers and dancers wearing fantastic costumes and wooden masks were preparing to entertain the audience between the speeches, but the audience was more interested in what was happening behind the performers: fifteen malaria testing stations had been set up, stocked with rapid diagnostic tests and staffed with community health care workers. Bales of insecticide-treated nets were piled nearby, ready to be handed out.
For more photos, visit our slideshow on Flickr.
“This is our pride”
Posted by Cristina Herdman, MACEPA Senior Communications Officer
"This is our pride, " said Boniface Chiluba, program officer for Churches Health Association of Zambia. He looked like a proud father as large crowds massed around the fifteen community health workers that his team had recently trained to administer rapid malaria diagnostic tests.
Having just completed training last week, the community health workers were set up at tables in the shade of thatched shelters administering rapid diagnostic tests earlier today to the dignitaries in attendance, including the Minister of Health and the local member of parliament. It was a powerful show of support and confidence in the professional abilities of the community health workers (and quite a first day of field work, I imagine, for the community health workers). Shortly after this first round of testing, the crowds—mostly women with small children—were 15-deep waiting to be tested and, if positive, to receive Coartem.
Minister Simbao undergoes a blood test for malaria (it came back negative). Photo: PATH/Todd Jennings.
Correctly diagnosing malaria and making effective medicines available is a cornerstone of stopping the disease and maintaining effectiveness of medicines. Until recently, people here in Katete had to travel, often long distances, for diagnosis (usually by microscope) and drugs. Churches Health Association of Zambia is training community health workers throughout Eastern Province to test and treat malaria, helping Zambia take a big leap forward in reaching rural people who are often most vulnerable to the disease.
Boniface Chiluba continued: “This step taken by Zambia with community health workers moves us toward a word that a lot of people fear: eradication. This is very good. I think we are doing very well in our country and moving in the right direction.”
Strong leaders, dynamic partners
Posted by Cristina Herdman, MACEPA Senior Communications Officer
Strong, committed national leadership and a dynamic, cohesive partnership were the qualities that several people talked about today when I asked them why they thought things seem to be working so well in Zambia. Dr. Boniface Mutombo wa Mutombo, the MACEPA country coordinator based in Lusaka, said it plainly: “The national leadership of Zambia, at the Ministry of Health and within the National Malaria Control Centre, are bright, committed people who want to see the partnership work well. In a certain way, the right people are all here at the right time, and I believe that it is the personalities that bring it together.” (Read more on the NMCC website.)
As I walked though the dry field where the dancers, singers, dignitaries, and one quite large python were recently, it occurred to me that everyone here seemed genuinely excited about what was happening. Not only did the crowd remain quite large in spite of the heat (and sudden rumors that the python had gotten loose), but all the partners seemed proud of what was happening on a larger scale in Zambia. Their many years of work had led to this day of commemoration and celebration of Zambia’s impact recently announced by the World Health Organization: a 66 percent reduction in malaria deaths. (See the announcement on WHO's site.)
Katie Barrett, a project officer from the Malaria Consortium, put it this way: “The Zambia partnership is strong, dynamic, and cohesive and works very well together. Not only the governmental and nongovernmental organizations, but community and faith-based organizations as well. Even today we had the police and the scouts involved, so it seems like every part of the community is really pulling together to make this a success.” Dr. Mutombo echoed this sentiment, saying, “Zambia has expertise and comparative advantages from one partner to another. When we all put these together, together with sufficient funds, there is quite a lot of added value to what we are doing.”
Katie Barrett reclines in the Zambulance, a new addition to rural health care here launched by Malaria Consortium and Zambikes. To speed access, patients referred to a rural health facility can now be transported in a padded trailer. (Yes, it is as comfortable as it looks.) Photo: PATH/Todd Jennings.
For more photos, visit our slideshow on Flickr.
Bringing health home
Posted by Cristina Herdman, MACEPA Senior Communications Officer
While celebration is rightly in order, malaria still thrives in parts of Zambia, as Todd mentioned in yesterday’s post. In the middle of the afternoon today when the sun was hottest, a woman began her walk back home along the red dirt road holding her young child’s hand, her small baby bound on her back, and two new bednets tucked under her arm. I wondered what she thought of the day, so I asked John Botha if he would translate my questions into her Nyanja.
Monica: two children, two positive malaria tests, two treated bednets. Photo: PATH/Todd Jennings. |
Monica seemed tired but in good spirits. She said that she was very happy to get the nets—she’d never owned one before and now she had two!—and that she is looking forward to sleeping under a net tonight, together with her young children. Monica has had malaria before, and only moments ago she learned that both of her children tested positive for malaria. She was happy to have gotten medicine for them both and seemed confident of good health ahead for her family.
The Zambian government is committed to making malaria control services available as close to home as possible, and from what I observed today, they are making good on their promise. RAPIDS is an nongovernmental organization that was founded to provide home-based care to people with HIV/AIDS, but which has also begun distributing and hanging treated bednets, administering rapid diagnostic tests for malaria, and giving medicine if needed.
I chatted with one of the RAPIDS rural health workers named Peter Raphael, someone who may one day visit Monica and her children at home to make sure their nets are hung up properly, test the family for malaria, or provide medicine. He smiled when I asked him how he liked his job. “I like my job very much because it is important; we reach so many people and prevent them from suffering from such a terrible disease.”
And so World Malaria Day has ended in Katete. We just came from dinner, where we saw several Katete residents still in World Malaria Day t-shirts. We heard malaria announcements on the radio and saw posters all around this small town. Counting out malaria is a message that has permeated Zambia and many other African countries. And now the countdown has begun.
Hope in Zambia
Posted by Todd Jennings, MACEPA Communications Officer
Entering Katete this afternoon, site of Zambia’s 2009 World Malaria Day festivities. Photo: PATH/Laura Newman. |
April 24, 2009, Zambia—Today Cristina, Laura, driver John Botha, and I made our way to Katete, a five-hour drive from the capital Lusaka. Zambia lives in an interesting neighborhood—for much of today we paralleled the border with Mozambique—and the long trip gave us plenty of time to reflect on the challenges and gains in malaria control here.
Landlocked by eight countries, Zambia is about the size of Texas but has only half as many people (Zambia’s population is about 12 million). Its location has been described as open to a one-two punch from disease: Zambia sits on the southern edge of where malaria is most intense—imagine a wide belt circling the globe around the equator—and the northern edge of where HIV/AIDS is most prevalent.
For many years malaria was seen as the biggest killer here, especially of young children. If left unchecked, malaria can devastate families, communities, and economies. A child misses out on education because a student home sick is not receiving her schooling, the best ticket out of poverty. A parent misses work to take care of her. The lack of income (and productivity at the workplace) is compounded by added costs of medicine and transportation.
Malaria is a huge burden to an already taxed health system, and its impact on business and economies means the continent is losing billions of dollars every year. This is why the global map of malaria (again, imagine a wide belt circling the equator) is basically a mirror image of the global map of poverty.
Sticker from motel door, indicating indoor residual spraying—combined with a treated bednet, we should be protected against malaria. Photo: PATH/Laura Newman. |
But there’s also plenty of hope to go around, too. Zambia continues to receive a lot of attention for its ability to meet its ambitious program goals and reduce the burden of malaria here (learn more on the website of the National Malaria Control Centre). The disease remains a huge burden for some parts of the country, but thanks to the government’s commitment and better testing, malaria is no longer the scourge it once was.
It’s late, so we’ll talk more about that and the World Malaria Day main events tomorrow. For now, we hit the pillow under a bednet at Mphangwe Motel, where there is evidence of the rooms sprayed earlier this year! Outside, the wind blows, bats squeakily devour mosquitoes, and stars blaze all the way to the horizon.
Sharing experiences—and lifesaving bednets
Posted by Laura Newman, MACEPA Communications Associate
April 23, 2009, Lusaka, Zambia—Tomorrow morning, Cristina and I will drive with Lusaka-based colleague Todd Jennings seven hours northeast, crossing the Chongwe and Luangwa rivers and arriving in Katete in the afternoon. A shipment of 6,000 insecticide-treated nets has already reached the town—ready and waiting to be distributed on Saturday.
Yesterday Todd showed us some great photos that he took of workers loading bales of the insecticide-treated nets onto the Ministry of Health’s National Malaria Control Centre (NMCC) trucks. The NMCC has been buzzing with activity during this last week. Everyone is clearly excited by the idea of commemorating World Malaria Day with meaningful action: distributing bednets (read more on the NMCC website), testing individuals for malaria, and filling in standing water holes.
Workers load insecticide-treated nets to be distributed by Zambia's National Malaria Control Centre during World Malaria Day activities. Photo: PATH/Todd Jennings.
Meanwhile, the workshop on long-lasting insecticidal nets is still going strong. The facilitators have been working late into the night to fine-tune their presentations for the next day, and informal cross-country learning has been happening all over the hotel.
And the big issues are emerging in force. Today workshop participants began to tackle the imposing logistics involved in distributing millions of nets: developing systems to track things like how many nets are needed in certain areas, how many nets have already been distributed, when they went out, whether they are long-lasting or regular nets, and when more nets will need to be delivered to replace old ones and to protect new families.
Another important topic on the agenda was usage. Claudia Vondrasek from the VOICES for a Malaria-Free Future project in Mali reminded us that distributing nets to people is one thing—but getting people to actually sleep under the nets they receive is a whole different, and critical, challenge. Read more about the VOICES project on the Johns Hopkins Center for Communications Programs website.
Last night, I joined a big group from the workshop gathered outside under the stars, boisterously discussing the scale-up of net distribution. When the conversation eventually turned to the day’s events, facilitators and participants alike reflected on the importance of bringing all of these malaria control experts together.
Marcy Erskine, a facilitator from the International Federation of the Red Cross summed it up best when she said, “What we’ve seen this week might not be best practices, but we’ve seen different practices, we’ve seen lessons learned—and the end result is shared experiences. We want to stay in touch, we want to move forward together as a unit.”
An ordinary van with a special mission
Posted by Asefaw Getachew, MACEPA Senior Technical Advisor
After playing music and educational videos, this mobile van's crew holds a malaria prevention quiz. Photo courtesy of USAID. |
April 22, 2009, Addis, Ethiopia—Weeks ago, on March 31, Ethiopia’s mobile van left Addis and began driving through the Amhara and Oromia National Regional states, stopping in a new town almost every day. It is an ordinary-looking van with a very special mission—in every town where it stops, it plays music, films, and videos that all have messages about how people can protect themselves from getting malaria. The messages and films are in Amharic (our national language) and other major languages, depending on what the local inhabitants speak.
Many Ethiopians visit their town’s market every day, so each time the van arrives in a new place, it parks right in the middle of the marketplace and passes out leaflets carrying key malaria messages. After playing the music and videos, the mobile van crew holds a malaria prevention quiz and gives out prizes to the winners. This road show is something we started doing last year in honor of the first World Malaria Day, and it was such a great experience that we decided to do it again this year.
And so far, it’s going very well! During last week alone, the van visited seven towns in the North Wollo and South Wollo zones. And the marketplaces have been a great way to reach farmers and others that live in rural areas. When someone who lives in a rural area gets really sick, it can take several people to carry him all the way to a health post or to a hospital where he can get the help. Because of this, one illness can end up affecting many households, so it is extra important that those who live in rural areas don’t get infected with malaria! This is why we have chosen to target these people during this month-long social mobilization campaign.
The mobile malaria messaging van will continue its work throughout the week and into mid-May. After holding a World Malaria Day 2009 press conference at the Federal Ministry of Health conference hall this afternoon, I am leaving for Kombolcha town to take part in Ethiopia’s national World Malaria Day commemoration ceremony and to join all of our partners, including our Minister of Health, in celebrating Ethiopia’s achievements in fighting malaria.
Day 1 of World Malaria Day activities
Posted by Cristina Herdman, MACEPA Senior Communications Officer
April 21, 2009, Lusaka, Zambia—There is a palpable feeling of excitement among malaria folks here in Zambia this week. The team at the National Malaria Control Centre and many partners—MACEPA among them—are getting ready to travel to the town of Katete, which lies about seven hours overland to the northeast of Lusaka.
Katete will be the heart of Saturday’s activities commemorating World Malaria Day in Zambia. Speeches and parades will be bypassed in favor of hands-on, old fashioned malaria control: at least 5,000 long-lasting insecticidal nets will be distributed, and high-level officials will submit themselves for rapid diagnostic testing. (Well, rapid diagnostic tests are not exactly old fashioned, but dignitaries being tested in public is a tried-and-true way to encourage everyone else to get tested, too.)
Another layer of excitement today involved a gathering of bednet distribution experts to participate in a four-day workshop on distribution of long-lasting insecticidal nets. The meeting was hosted by the MACEPA Learning Community, with support from Malaria No More, UNICEF, WHO, the International Federation of the Red Cross, and the VOICES Project of Johns Hopkins—together making up a seriously experienced group that has been doing a road show of sorts, having done these trainings on long-lasting insecticidal nets in four countries in the last several weeks.
Participants in the workshop on distribution of long-lasting insecticidal nets listen to a question about the Uganda country presentation. Photo: PATH/Laura Newman.
This gathering of national experts is a rare opportunity for countries facing similar challenges in moving some impressively large quantities of long-lasting insecticidal nets to people who need them. Today folks from Zambia, Uganda, Malawi, Ethiopia, Zimbabwe, and Tanzania started the workshop off with summaries of what they’ve been doing, what has worked well and why, and what has been hard.
We heard that, even though some countries are far along in achieving scale-up while others are taking early steps in the journey, they all experience many similar challenges and concerns: how to strengthen leadership, define the role of the private sector, get people who own nets to hang them up and sleep under them, and sustain gains made in distributing nets that have a limited lifespan in countries with growing populations. The goal of universal coverage with long-lasting insecticidal nets is on every country’s agenda—“elimination” was the word of the day.
One participant from Ethiopia said something that really struck me: “It will serve no good if only one of us does well. We must stay in touch, help each other, and give encouragement—because for this job to succeed, we must all do well.” It was nice to hear the true mission of the Learning Community so movingly expressed.
Dr. Boniface Maket, the deputy director of the MACEPA Learning Community, seemed equally pleased with the outcome of day 1 of the workshop: “I believe that this is the beginning of a very fruitful and supportive working relationship among these committed partners, with learning opportunities for all.”
Dr. Victor Mukonka opens the workshop on long-lasting insecticidal nets. Photo: PATH/Laura Newman. |
Perhaps I’ll leave off with the workshop’s opening remarks from Dr. Victor Mukonka, Zambia’s director of Public Health. “We cannot reach these targets in isolation. . .Shared learning will help us learn from each other efficient and effective ways of planning and coordinating scale-up. . .Let us use this workshop to help us develop practical strategies to achieve our goals. . .This workshop should not be an end in itself, but rather a giant leap forward toward achieving universal coverage of long-lasting insecticidal nets.”
We on the MACEPA team are looking forward to an exciting week. We’ll keep you posted, from a variety of perspectives, over the next several days. Please check back in!
World Malaria Day and this diary
Saturday, April 25, 2009, marks the second annual World Malaria Day, an event that will be commemorated around the world with the distribution of bednets and medicines, concerts, speeches, prayers, congressional briefings, sporting events, and much more.
This year’s theme for World Malaria Day is “Counting Malaria Out,” referring to the malaria community’s countdown to 2010. The UN Secretary-General Ban Ki-Moon has called for providing effective and affordable protection and treatment to all people at risk of malaria by 2010. Read more and see the countdown on the World Malaria Day website.
PATH’s staff and our partners are providing on-the-ground coverage of World Malaria Day activities in Zambia and Ethiopia. We will post here daily, starting April 21—sharing photos, audio clips, and our reflections on events as they unfold in Zambia's capital city of Lusaka and Katete District in Eastern Province and in Ethiopia's capital, Addis Ababa.
Please join us, and all of our partners, as we celebrate successes in fighting malaria, remember those who have died from the disease, and come together to count malaria out.