Charting progress toward a malaria-free Zambia

December 21, 2023 by PATH

Initiatives like the U.S. President’s Malaria Initiative PAMO Plus program have been pivotal to Zambia's malaria elimination efforts and underscore the importance of collaborative efforts in tackling global health challenges.

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Community Change Agents share what inspires them to work with pregnant mothers with PMI PAMO Plus staff following a community dialogue in Muduwa, Mkanda, Eastern Province. Photo: PATH/Joy Talemwa.

Despite significant achievements in malaria reduction over the past decade, malaria remains a pressing public health issue in Zambia. The country sees more than 3 million cases annually, with pregnant women and children bearing the heaviest burden of malaria.

The U.S. President’s Malaria Initiative (PMI) PAMO Plus program, implemented by PATH with funding from PMI in Zambia, aims to reduce malaria illness and death by improving prevention, detection, and treatment of the disease in Zambia’s Eastern, Luapula, Muchinga, and Northern Provinces.

In the stories below, we explore the many noteworthy successes achieved by PMI PAMO Plus in 2023 to ensure high-quality malaria data, increase access to malaria services, and engage and educate communities on life-saving malaria interventions.

At the heart of these successes are the dedicated community health workers (CHWs) fighting malaria across Zambia. Expanded to more than 26,000 strong through a decade-long collaboration between the NMEC, PATH MACEPA, Malaria Partners Zambia, and other partners, Zambia’s robust network of CHWs has become the backbone of the country's malaria elimination efforts.

Facilitating data-driven decision making at the national level

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Community Health Worker Grace Lungu shows U.S. Global Malaria Coordinator, Dr. David Walton, how she verifies data in her malaria rapid diagnostic test register with Mukomela Banda, PMI PAMO Plus Surveillance Officer. Photo: PATH/Joy Talemwa.

One of the key responsibilities of CHWs is to report malaria surveillance data collected in health facilities and within communities. This year, PMI PAMO Plus facilitated mentorship visits to build CHWs’ ability to report malaria cases accurately and in a timely manner.

Grace Lungu is one of the CHWs responsible for data reporting in Zambia’s Eastern Province. Grace was inspired to become a CHW more than a year ago after seeing the negative effects of malaria on her fellow community members.

Through the mentorship visits facilitated by PMI PAMO Plus, Grace gained the skills needed to confidently collect malaria testing data, gather data from four other CHWs, and accurately input this information into a national malaria data management platform called DHIS2. She shares that the most rewarding part of her work is seeing how every bit of information she records influences decision-making processes at the national level.

Through these trainings and the work of CHWs like Grace, PMI PAMO Plus helps ensure high-quality data are available to support decision-making around lifesaving interventions like the distribution of insecticide-treated bed nets, administration of indoor residual spraying, and procurement and stocking of malaria prevention medication for pregnant women in Zambia.

Taking a comprehensive approach to curbing malaria transmission

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CHWs in Sinda investigating potential Anopheles mosquito breeding in a pond located near a household with a confirmed malaria case. Photo: PATH/Webby Phiri.

CHWs are also integral to Malaria Case Investigation (MCI), a key malaria elimination strategy in areas with low malaria transmission. This year, PMI PAMO Plus teams trained 169 CHWs to implement MCI in 10 health facility catchment areas in Zambia’s Eastern Province.

MCI involves tackling malaria transmission in low-burden areas at both the individual- and community-level within seven days of a case being identified. Once a malaria case is identified and treated, CHWs test and treat all household members living with a 140-meter radius for malaria within three days. Then, within seven days, CHWs mount an appropriate community-level response to prevent further transmission.

First designed and implemented in Zambia’s Southern Province through a collaboration between PATH MACEPA and the NMEC, MCI is now being expanded into low-burden areas of the Eastern Province using best practices and lessons learned in the Southern Province.

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Community Health Workers examine a sample of water for mosquito larvae with Malaria Case Investigation (MCI) trainers from the Ministry of Health and Dr. Webby Phiri, Technical Director with PMI PAMO Plus. Photo: Sinda District Health Office/Towela Banda.

Through trainings PMI PAMO Plus conducted this year, CHWs learned how to identify malaria cases using Rapid Diagnostic Tests, provide appropriate treatment to positive cases, and administer community-level interventions to prevent further spread of malaria in the area.

These community-level responses include identifying and removing potential breeding sites for malaria-carrying mosquitoes by examining water samples for mosquito larvae, clearing stagnant streams, and applying larvicides. Through coordinated actions like these, CHWs prevent local malaria cases from becoming large outbreaks.

Tailoring social and behavior change activities for communities served

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A community member discusses SBC messages with Madrene Phiri using sign language during a community dialogue at the Magwero school, Chipata, Eastern Province. Photo: PATH/Chanda Mando.

Community Change Agents (CCAs) are a subset of CHWs who leverage social and behavior change (SBC) and interpersonal communication (IPC) strategies to empower communities to take malaria prevention into their own hands. They interact with community members and help them identify how community behaviors contribute to malaria transmission, discuss barriers that hinder access to health services, and help foster case-seeking behaviors.

This year, PMI PAMO Plus trained 18 CCAs in the Magwero community in the Chipata District of Eastern Province—a community that has some of the highest numbers of malaria cases across the district.

Through community consultations, PMI PAMO Plus learned that SBC activities were not reaching students in the Magwero school, a school for young people with hearing and speech impairments, because none of the trained CCAs knew sign language. To address this communication barrier, PMI PAMO Plus trained Madrene Phiri, a 26-year-old woman who is fluent in sign language, as a CCA.

Now, Madrene conducts community dialogues and health talks among the Magwero community members with hearing and speech impairments. By tailoring prevention activities for the communities served, PMI PAMO Plus ensures equitable reductions in malaria, especially among vulnerable populations.