The heroes of malaria elimination efforts in Zambia

Lawrence Mweemba, a community health worker in Zambia, can’t remember the last time he had malaria.

“Maybe 20 years ago?” he said.

Fortunately, this is the case for many people living in the country’s Southern Province, where more than 60 percent of malaria cases are now managed at the community level.

In Chikankata District, the goal is not to manage malaria, but to end it. The flow of timely and accurate malaria data tracks remaining transmission, and a confirmed case triggers a comprehensive response to contain the infection and prevent spread.

Community health workers are volunteers nominated by their communities to provide care at the household level. They are trained to test, treat, and track malaria; review and report malaria data; support vector control campaigns; and educate and sensitize communities on malaria. They also identify and refer cases of diarrhea, malnutrition, and respiratory infection.

A study on managing malaria at the community level in Zambia showed that adding a health provider to an area was associated with a 19 percent reduction in severe malaria and 23 percent reduction in deaths in children.

As trusted members of the community, their goal is to catch and clear infections early. By bringing malaria services and treatment to their neighbors—the Ministry of Health’s mission is “To provide equitable access to cost-effective, quality health care as close to the family as possible”—these community health workers are helping end local malaria transmission.

At PATH, we provide technical guidance and support for malaria surveillance by community health workers and their health facility–based supervisors, including the visualization of malaria data for decision-makers at all levels. In collaboration with the National Malaria Elimination Centre, PATH has also facilitated investment in community health workers by other partners—most recently for malaria case investigation in areas of very low transmission.

To uncover some of their personal experiences and motivations, we spoke with four community health workers in Chikankata District in rural Zambia. Meet Lawrence, Emely, Invester, and Jenipher.

Lawrence Mweemba has spent the last decade working as a community health worker in Chikankata District, an area classified as “low transmission,” meaning there are less than 50 cases per 1,000 people.

A typical day for Lawrence involves visiting members of his community in their homes to test for malaria and ensure any positive cases are treated and reported through a web-based surveillance system.

One of the key challenges of working as a community health worker is transportation.

“In 2012, we were given bicycles, but many of them are now damaged, and we need to walk on foot, sometimes up to 12 km a day,” Lawrence said. “I also need to balance the time between my family, who needs me, and my community, who also needs me.”

Despite these challenges, Lawrence's motivation for his work stems from his dedication to the community.

“They appreciate our help in shortening the distance between them and the health facility. We go to people’s doorsteps instead of them needing to come to us.”

Emely Malunga works as a community health worker in the Kasengo Ward of Chikankata District and, like Lawrence, has served her community for more than ten years. As well as testing, treating, and tracking malaria cases, community health workers also carry out entomological investigations to identify and remove potential mosquito breeding sites.

“We have been able to increase the community's understanding of where mosquitoes breed, including the fact that they can be found in small water sources close to homes, not just in rivers or large bodies of water,” Emely said.

This intervention is part of a comprehensive response that includes strategies such as indoor residual spraying, long-lasting insecticide-treated bed net distribution, larviciding, and health promotion to raise awareness about the disease and preventative methods among community members.

Invester Hamunyinza plays a key role in keeping her community safe. She follows up on confirmed cases by visiting the patients’ homes, as well as their neighbors’ homes, to test for malaria parasites in their blood. If anyone tests positive, she provides treatment on the spot.

Invester has noticed a significant reduction in malaria cases and deaths among her community over the last ten years.

“I’ve noticed change at my own household level and within the community,” she said. “I’m hardly reporting any malaria cases and am able to treat any cases that do arise promptly.”

In 2022, only five cases were identified in the Muyoma area, where Invester lives. This reduction can be, in part, attributed to the improved malaria case investigation and increased access to malaria services in her community.

Invester continues going out into the community, but today, people are also aware that they can access services at Invester’s house.

“It’s great that I am equipped with this knowledge—it means this can be accessed at my household.”

She also acknowledges the improved reporting and testing processes.

“We now use additional reporting tools such as registers and notification forms. When a case is found, we do a follow-up to test other household members, and this will be captured in the database.”

Most malaria community health workers are volunteers who do not receive any payment for their work. Jenipher Mumba tells us this can be challenging, especially when they work alongside other health workers who are paid a stipend.

“There are HIV agents also working in the community. We go together to the same homes, and they get a lunch allowance, but we don’t get anything.”

That's why PATH is working with the Zambian Ministry of Health on a community health worker strategy that aims to harmonize incentives across the various public health programs.

Jenipher says the most rewarding aspect of her work is the relationships she has built with members of her community.

“The advantages are that people in the community begin to support me with my challenges. I have built strong relationships with them. People show love and care back and want to help you because they recognize what we are doing for them.”

Without the dedication of community health workers, millions of people—particularly hard-to-reach populations—would not have access to lifesaving care. Community health workers like Lawrence, Emely, Invester, and Jenipher truly are the backbone of malaria elimination efforts.