18 April 2018

Zambia: Country Case Study - The First Large Sub-Saharan African Country to Achieve Malaria Elimination?

Photo: Geoff Ward for Malaria No More UK
A Ghanaian volunteer who distributed malaria nets, with his daughter.
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On World Malaria Day last year Zambia announced its National Malaria Elimination Strategy, with 2021 as the target date for elimination. On World Malaria Day this year, Zambia will launch a new high level multi-sectoral End Malaria Commission and a multi-sectoral business plan in order to help achieve this.

If Zambia were to achieve elimination, it would be one of the first countries in Africa to do so.
There has been extraordinary leadership from the Government of Zambia and the Ministry of Health on malaria; they have shown initiative and innovation from the outset and have been a leader in the region in demonstrating how the fight can be won.

Zambia was the first African country to use Artemisinin Combination Therapy (ACT) — the medicine that replaced chloroquine as the frontline treatment of the disease—and was one of the first to introduce rapid malaria tests.

In 2006 the Ministry of Health was also one of the first to start conducting nationwide household surveys to track malaria prevalence; when they conducted a second survey in 2008 they found malaria rates in children were cut in half. This year Zambia is conducting its sixth nationwide malaria survey, more than any other country on the continent.

According to the Ministry of Health, the number of deaths from malaria have decreased by 43 percent from over 3,200 in 2014, to under 1,900 in 2016. Approximately, 70% of the population has access to a bed net or indoor residual spray – proven tools to fight the disease.

So how has Zambia achieved this success?

Zambia has the highest level of domestic funding per person at risk of malaria in East and Southern Africa. Domestic financing has increased from $8.2 million (pre-2015, rising to over $28 m per annum currently with the potential to increase again to 2020). The national health budget has grown from 9 percent three years ago to around 11 per cent. They also have several innovative programmes around the country.

The Ministry of Health, through the National Malaria Elimination Programme, continues to apply cutting edge approaches as part of its elimination agenda.  This is especially true in Southern Province, home to Lake Kariba, the largest man-made lake in the world and also a breeding ground for the mosquitoes that carry malaria.

  • Human bait volunteers are employed from 6pm to 6am to catch live mosquitoes as they bite them, using a mouth aspirator. This is to help scientists study the density, types and human-biting behaviour of the female anopheles mosquito that spreads malaria.
  • Malaria mass drug administration (MDA), where every eligible person in a community takes malaria treatment regardless of symptoms, was trialed in Zambia in 2014 along Lake Kariba.  
  • Two years later the study areas had an 87 percent reduction in malaria and a 97 percent in facility-reported malaria deaths; by the end of the research more than half of the study health facility areas had zero malaria infections.  
  • Based on the results of the study, Zambia's national programme added malaria MDA to its arsenal of interventions. In a recent round 240,087 people were treated.  Malaria MDA at this scale has not been seen on the continent in 50 years.
  • To maintain lower levels of transmission, Zambia has trained thousands of community health workers to follow up on individual malaria cases, clearing communities of the parasite, and to report the surveillance data via their mobile phones.
  • Zambia is home to some of the latest technological innovations and partnerships.  Visualize No Malaria, for example, is an initiative of the Government of Zambia, PATH, the Tableau Foundation, and a number of other technology partners.  Together, this coalition of tech companies are each applying their tools, resources and expertise in a united pursuit of malaria elimination.  The result? Front line health workers are being armed with data visualization tools and analytical skills to improve reporting and to make informed decisions on managing malaria and deploying appropriate resources in their area.


These approaches from the southern part of Zambia are now being introduced into other areas of the country. The country's success is also due to a rich history of private sector investment.  From copper mines to sugar plantations, business has been active in prioritizing malaria prevention and control efforts for their employees and surrounding communities.

Zambia also plays a key role in a Southern Africa regional project, where eight countries have joined forces to stop malaria from being transmitted across national borders, with the ultimate goal of eliminating malaria transmission in the regional altogether by 2030. This is particularly important as many of the neighbouring countries (DRC, Malawi and Mozambique) have high malaria transmission rates. Zambia is a prime example of what can be achieved through political and financial commitment, evidence-based innovation and strong partnerships.

 

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