14 November 2005

Zambia's National Malaria Control Program Expands, Intensifies with Lift from New Partners

Livingstone — Although largely unnoticed in the developed world, malaria strikes 500 million people a year and kills nearly a million children younger than five, mostly in sub-Saharan Africa. Treating the disease absorbs a significant amount of income in poor households, and the economic and social effects of chronic infections are a major obstacle in Africa's progress towards the UN Millennium Development Goal of reducing severe poverty.

In May this year, the Bill and Melinda Gates Foundation announced a $35 million grant to PATH, a U.S.-based non-profit organization, to develop and demonstrate strategies that can successfully curb malaria's spread. The result is the Malaria Control and Evaluation Partnership in Africa (Macepa), which is funding an in-country collaboration among PATH, the government of Zambia, and the Zambia Roll Back Malaria Partnership. The project is supporting "the coordination of a rapid implementation of proven malaria-control strategies - including insecticide-treated bed nets, indoor mosquito control, and effective medication."

Directing Macepa is a veteran malaria fighter, Dr. Carlos (Kent) Campbell, a former head of the Malaria Branch at the U.S. Centers for Disease Control, who says the support of the Gates Foundation has transformed the global approach to deadly diseases. The foundation's strategy is "breathtaking," he says, giving public health officials an unprecedented freedom to think new thoughts, build new alliances and achieve new successes.

AllAfrica's Margaret McElligott has taken a close-up look at Macepa's early efforts.

Zambia's national malaria control program is rolling ahead with massive anti-malarial interventions, including indoor residual spraying, artemisinin-based combination therapies (ACT) in government health clinics and more than 500,000 insecticide-treated bed nets and 500,000 retreatment kits.

The coordinated response is part of the Malaria Evaluation and Control Project in Africa (Macepa), recently launched with the aim of reaching 80 percent of the population and reducing malaria-related deaths by 75 percent within three years in the first battleground country, Zambia. Its success will serve as a model for other African nations.

The distribution of bed nets in health clinics and homes began before last week's symbolic handover ceremony from PATH and the Bill and Melinda Gates Foundation to Zambia's Ministry of Health. Officials from PATH, a U.S.-based non-governmental organization working to improve health technology in developing countries, said the speed of the bed net rollout shows the partnership's commitment to fighting malaria. They said the introduction of new technologies has made malaria a preventable and treatable disease.

"Malaria remains the number one killer in Zambia and as such, the Ministry of Health has worked to control and eradicate it," said Chilufya Kazenene, Zambia's deputy minister of health.

At least 40 percent of Zambia's childhood deaths are caused by malaria, according to the Zambia Malaria Foundation, and the parasite is a huge burden to the country's productivity and agricultural development. Average households in Zambia experience 2.4 cases of malaria each year.

Kazanene said that government is providing direction for all anti-malaria activities undertaken by partners.

"The national strategic plan will provide the framework to scale-up efforts," he said at the handover ceremony.

Development partners, especially the Gates Foundation-funded PATH, said cooperation on the national plan is unique because of the leadership role taken by government in developing the national strategy. Instead of each organization funding their own priorities, donor agencies are cooperating to achieve the goals set by the Ministry of Health's national malaria control plan, said Dr. Kent Campbell, program director at PATH.

Campbell said that PATH and the Gates Foundation hope to demonstrate that malaria can be eliminated in Zambia, which can then be used as a model for anti-malaria efforts elsewhere in Africa. Large investments by the Zambian government, the Gates Foundation, the World Bank, the Global Fund to Fight Aids, Malaria and Tuberculosis have combined so that the national effort can tackle malaria prevention and treatment comprehensively across the country, he said. Campbell said the Global Fund provides crucial partnership and influence on the African continent because it has given governments the resources to negotiate with and exert control over other donors, as well as the confidence to get into dialogue with partners.

"There's a strong political agenda here," Campbell said about his desire to publicize the work of the anti-malaria partnership. "This has to be a national story. It has to have a national voice and a national face to it."

Between 2003 and 2004, Zambia recorded a drop in deaths due to malaria from 50,000 to 30,000, and officials hope the aggressive malaria control strategy will result in even fewer deaths this year. Part of the decline is due to the government's decision to use ACT for treatment in all government health clinics, a move Campbell said was bold considering the high cost of the drug, but the "right thing to do."

Zambian health officials say they appreciate the role played by PATH and the Gates Foundation in following the government's lead on malaria.

"This is a new partner that has come on the floor with so much steam and so much enthusiasm to work with as a partner," said Dr. Naawa Sipilanyambe, acting coordinator of the National Malaria Control Center. "We are moving in the right direction. Let us continue working together."

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