Zambia pushes on to end malaria

Zambia has made great gains against malaria over the last decade, but the country still sees more than five million cases each year. The Zambian government is addressing this challenge at both the national and community levels with the support from the Program for the Advancement of Malaria Outcomes (PAMO).

Funded by the US President’s Malaria Initiative, PAMO’s strategy centers on increasing coverage of proven malaria interventions, strengthening program management capacity, and improving systems and culture around data use in decision-making.

Since 2017, more than 2,500 community health workers have been trained and deployed, and onsite case management mentorship has been provided to more than 1,200 health care workers. As a result, nearly 120,000 children who tested positive for malaria have been treated. Furthermore, health facilities increased their reporting of complete malaria data from 87% to 100%, while also improving data accuracy by 25%.

The success of these efforts reflect the fact that all stakeholders are committed to people-centered solutions, data-driven decision-making, and collaborative alignment in strategy and implementation. Here are some of the lessons we learned along the way:

The first important step was to center the strategy on the many players working to eliminate local malaria infection. This allowed us to increase the efficiency of delivering interventions, and to promote the collective accountability amongst everyone involved. An inclusive, consultative process laid the groundwork for continued partner alignment, resulting in a harmonized national work plan and mechanisms for tracking progress against targets.

At the health facility level, workers receive regular supervision and mentorship to continually improve the quality of care delivered at every stage—from accurate diagnosis to treatment. PAMO increased both the number of health care workers receiving this supervision and the variety of those delivering it. The mentorship team of laboratory specialists and clinicians was expanded to include pharmacists, maternal and child health specialists, and district information officers who provide instruction on supply chain logistics, treating malaria in pregnancy, and improving data quality.

Health care workers are extending malaria diagnosis and treatment to the community level by leveraging integrated community case management (iCCM). The approach is helping make community health workers a one-stop-shop for uncomplicated malaria care. They are nominated by their own communities; they are trusted, respected, and well-connected. They speak their own language—literally and figuratively. Each community health worker is responsible for between 500 and 700 people and together they form a network of access across hard-to-reach areas.

As of March 2020, PAMO has supported the training and deployment of 2,533 community health workers across 12 districts, representing a 7% contribution to Zambia’s goal of deploying 36,000 trained community health workers by 2021 to ensure access to community-based malaria care across the country.

Since some data from the health facilities are still recorded on paper, PAMO facilitates audits for data quality to help health care workers compare to what is captured in the health management information system. This helps to identify mistakes and the underlying actions behind them to course correct.

“We have noticed a significant improvement in data quality from our health facilities. Clearly, PAMO’s regular support to improve the way we manage data is paying off. During our data review meetings, you can clearly see the effort health care workers are making to improve data quality,” noted Dr. Bernard Chimungu, health director for Sinda District.

Those efforts to improve accuracy and timeliness at the facility and district level are critical to the program management tools used at the provincial and national levels. The malaria scorecard (pictured above), a data visualization platform, marries the work done to align donors and implementing partners around a single work plan with efforts to track performance of key malaria indicators. From the National Malaria Elimination Centre to provincial and district health offices—and soon health facilities—the scorecard helps identify issues, locate resources, reorient programs, and resolve implementation challenges.

PAMO’s learned experience, deep partnerships, and commitment to a measured approach have compounded over time, resulting in great advances in the delivery of malaria care.