When Dr. Caroline Phiri-Chibawe was growing up in Zambia, malaria and fever were almost synonymous. As a medical student, she recalls being taught that “fever equals malaria” because the disease was so prevalent.
Although there has been tremendous progress since then, Zambia’s malaria burden remains high. The country reported around 7 million cases of malaria in 2020.
As a trained medical doctor with more than 20 years of public health experience, Caroline has made significant contributions to malaria elimination efforts in Zambia. Before joining PATH in 2018, she worked for Zambia’s Ministry of Health, where her work focused on maternal and child health.
In her current role at PATH, and in close collaboration with the country’s National Malaria Elimination Centre, Caroline leads the PAMO Plus project (funded by the US President’s Malaria Initiative [PMI]), which aims to improve the prevention, detection, and treatment of malaria in high-burden areas.
In this edition of PATH Malaria Perspectives, Caroline shares her reflections on how the PMI PAMO Plus project is addressing some of the most challenging aspects of malaria prevention in Zambia.
A: Zambia is a malaria-endemic country, but the situation isn’t the same in all areas of the country. Some areas have a high burden of the disease and others have a low burden. For example, malaria is particularly prevalent in the northern part of the country, but less so in Lusaka and Southern Province.
The average incidence of malaria in Zambia is 340 cases per 1,000 people, and 8 deaths per 100,000 people. Although we have seen a significant reduction in the number of deaths over the years, the number of cases is still quite high.
One of the biggest challenges is maintaining consistent funding and supply of commodities like antimalarials and rapid diagnostic tests. This was particularly challenging during the COVID-19 pandemic.
Pair this with the fact that many facilities still aren’t able to produce or share quality, timely, and complete health data, and you see that the initial challenge is not easy to address on a large scale.
Through the PMI PAMO Plus project, we are working in close collaboration with the National Malaria Elimination Centre (NMEC) to address these challenges directly. We are already seeing great improvements.
Q: What are the key goals of the PMI PAMO Plus project?
A: The project aims to address a number of malaria-related challenges. For example, we partner with the Zambian government to improve case management at both health care facilities and the community level. This involves training community health workers (CHWs) and improving the quality of care in malaria diagnosis and treatment.
Another important area of focus for us is maternal health. We protect expecting mothers from malaria by making sure they have access to quality preventive services during their pregnancy through early prenatal care visits.
Finally, across all our work, we prioritize gathering and utilizing data on malaria prevalence and outcomes, from both health facilities and communities, to make informed decisions backed by evidence.
Yes, social and behavioral change is an integral part of our work. The goal is ultimately to influence the way people access malaria interventions.
We do this through interpersonal communication, which involves training members of the community to encourage others to use malaria interventions. These community members are then able to identify current barriers and also educate their peers on the benefits of using certain interventions.
To support this, we partner with traditional leaders and religious leaders—who are already trusted within the community—to spread the message on malaria interventions. This could involve advocating for the use of insecticide-treated mosquito nets or indoor residual spraying in homes.
Q: What is the role of community health workers and how has the project supported them?
A: CHWs are members of the community who are trained on malaria management. CHWs know how to identify, test for, and treat a positive case.
Within their community, they visit people’s homes to provide care. This means we can provide malaria interventions and treatment even in hard-to-reach, rural communities. CHWs also collect data that is shared with the NMEC.
Once we have the data, we can visualize and analyze it to identify trends, which are then used for decision-making and strategizing at national and local levels. Working with CHWs has led to great improvements in how malaria is managed at the community level.
For example, we have trained more than 7,000 CHWs and they are now diagnosing around 42 percent of malaria cases in the areas they operate in. To support their work, we make sure they can access ongoing training and mentorship, which has been received very well.
Q: What motivates you in your daily work?
Working so closely with people and communities is truly rewarding. I remember taking a visitor from the US President’s Malaria Initiative to meet some CHWs and it was fantastic to see how they carry out their work.
The CHWs were testing for malaria in people’s homes and we saw how they are equipped to take the necessary action depending on the test result. If it’s malaria, they can treat them there and then, and if it’s not malaria, but the patient still feels ill, they can refer them.
Working with people who are dedicated to the health of their community makes me very happy.