Twenty years ago, PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) was established in Zambia with funding from the Bill & Melinda Gates Foundation. MACEPA was started to support the renewed efforts to control–and ultimately eliminate–malaria in Africa.
“MACEPA has been the foundation of PATH Zambia since we began in 2004,” says Dr. Nanthalile Mugala, PATH Chief of Africa Region. “Most people knew us by MACEPA well before they knew us as PATH!”
At the time, the global fight against malaria had stalled and the disease was on the rebound following a long-abandoned eradication campaign. Malaria burden was high, and financing was too low to seriously address the challenge. A bold approach was needed to shift from a distant, unattainable goal to an achievable target backed by strong political and financial commitment and coordinated, evidence-driven action.
"Those of us in the public health programming community must orchestrate a continually impressive series of meaningful successes...We must be successful in the ‘hard places'. These are the remote, low-resource areas where infrastructure is limited, and delivery systems are challenging,” said the late Dr. Kent Campbell, MACEPA’s creator and first director. “Given the right tools and financing, national programs can make an enormous impact."
MACEPA was created to do just that: to design, implement, and monitor impactful malaria control and elimination strategies, and to strengthen systems with quality and timely malaria data.
“Since our inception, MACEPA has dedicated resources and expertise towards the fight against malaria in Zambia,” said Kafula Silumbe, Team Lead of MACEPA Zambia. “Our priorities echo those of the Ministry of Health’s mission to provide equitable access to cost-effective, high-quality health services as close to the family as possible.”
Pioneering an approach to malaria prevention
In partnership with the Zambian Ministry of Health, MACEPA was instrumental in conducting the first-ever Malaria Indicator Survey in 2006. This national survey is now the global gold standard for measuring a country’s malaria prevalence, intervention coverage, and overall progress in fighting the disease. To address gaps and challenges identified in the survey, MACEPA collaborated with the Zambian government to implement Scale-Up for Impact (SUFI), an initiative to rapidly deliver proven malaria tools nationwide.
SUFI resulted in drastic reductions in malaria in Zambia, which became the first country in Africa to successfully achieve high coverage of insecticide-treated bed nets, indoor spraying of insecticides, and new diagnostics and medicines. The SUFI approach soon became the standard for malaria control and was included as a core component of the Roll Back Malaria Partnership to End Malaria’s Global Malaria Action Plan.
In areas of very low transmission, community health workers are trained in Malaria Case Investigation which includes identifying potential mosquito breeding areas near households with a confirmed malaria case. Photo: PATH/ Webby Phiri.
In the nearly two decades that have followed, MACEPA continues to focus on impact. For example, in collaboration with the National Malaria Elimination Centre (NMEC), MACEPA began to research the optimal mix of interventions that are needed, across the range of malaria transmission levels, to sustainably reduce the burden of disease in Zambia’s Southern Province. The lessons learned have since been used by the NMEC and partners countrywide. MACEPA provides strategic support that includes data-driven planning, intervention design and rollout, and consultation with key stakeholders to track and strengthen health service delivery.
Optimizing interventions with data and partnership
MACEPA collaborates with the national malaria program to identify needs and test solutions, and then coordinates partner support to scale up effective strategies under the leadership of the Ministry of Health. A prime example is Malaria Case Investigation (MCI), introduced in 2021 by the NMEC and MACEPA in two districts in Southern Province to help prevent outbreaks in areas with very low malaria transmission. Last year another district was added with support from the Global Fund, and that same year, MCI was expanded to the Eastern Province by the U.S. President’s Malaria Initiative PAMO Plus project.
MACEPA and the NMEC have collaborated extensively on research to advance innovative approaches. MACEPA’s operational research generates evidence on interventions that support decision-making on malaria policies and programs in Zambia. For example, a MACEPA-supported study conducted along the shores of Zambia’s Lake Kariba provided valuable evidence that led to Zambia adding mass drug administration (MDA) to its arsenal of proven interventions to fight malaria.
PATH collaborates with the Ministry of Health on surveillance, including in-country genomic sequencing. This can be used to track patterns of disease transmission and for early detection of outbreaks. Photo: PATH/ Enoch Kavindele Jr.
MACEPA also supports laboratory research, including establishing a molecular container lab in 2013 based at the national malaria program. MACEPA and NMEC laboratory staff help combat biological threats to progress against malaria, working to detect the historical presence of the malaria parasite, read sections of DNA for resistance markers, and to identify the range of mosquito species in Zambia from field collection at sentinel sites.
In 2019, MACEPA staff supported the Mobile Malaria Project to show that it is possible to sequence DNA in remote settings, the success of which led to the launch of the NOMADS project (and now NOMADS 2). During the COVID-19 pandemic, the lab team provided extra capacity to sequence SARS-CoV-2 infections in partnership with the University of Zambia, and were the first African team to identify the Beta variant outside of South Africa.
To strengthen community health systems and malaria data quality, MACEPA collaborated with the NMEC to design and introduce a nationwide system of community health workers (CHWs). MACEPA and the NMEC trained, equipped, and deployed CHWs to test, treat, and track malaria, as well as collect and record high-quality and timely data submitted to the national HMIS via mobile phone. Thanks to this collaboration between the NMEC, MACEPA, and six other partners across all 10 provinces, Zambia’s network of CHWs has grown to be more than 24,000 strong. CHWs trained by MACEPA and the NMEC serve as the backbone of Zambia’s efforts to improve data quality and reduce the distance to health services so infections are detected early, significantly reducing cases of severe malaria and deaths.
The high-quality, timely data generated by this national network of CHWs and health facilities sheds light on local malaria burden and transmission in Zambia. MACEPA provides training and support to ensure these data can be leveraged to guide decision making for malaria, including subnational tailoring of malaria programs.
MACEPA also provides training to strengthen the modelling and analytics skills of national malaria program staff and builds mathematical models that estimate the potential impact and cost-effectiveness of malaria interventions. Leveraging the strengthened data systems and new tools developed by MACEPA, the NMEC can use prioritization mapping to determine where interventions could have the largest impact and inform, for example, the strategic deployment of CHWs to achieve the greatest impact with available resources.
MACEPA worked with Zambia’s national malaria program to design and rollout a system of community health workers who are trained to test, treat and track malaria. By leveraging partner investment, the network is now nationwide. Photo: PATH/ Todd Jennings.
To help present malaria data so that it can be more easily understood and used by decision-makers, PATH MACEPA also supported the creation of customized dashboards based on needs identified by the Ministry of Health in partnership with Tableau Foundation and a coalition of tech companies. The dashboards are available to Ministry of Health personnel at all levels, and the visualizations help guide discussions during the NMEC’s monthly directorate meetings.
“MACEPA has strengthened how we monitor and measure our work, and in doing so, has added to the evidence base for the benefit of Zambia and the global malaria community.”— Dr. Busiku Hamainza, Acting Director of Zambia’s NMEC.
PATH MACEPA is proud of our partnership with Zambia’s National Malaria Elimination Centre. Together, we have learned so much and seen incredible progress towards a world where Zambia and its partners continuously expand the toolbox, evidence, resources, and political will to control, eliminate, and eventually eradicate malaria. Lessons learned in Zambia are now exported to other malaria-endemic geographies, helping ministries of health develop impactful, data-driven strategies and strengthened systems to drive the fight against malaria within their countries.
The impact of our work together over the last two decades is reflected in remarkable progress against malaria in Zambia. For example, several communities in Southern Province have not only achieved but maintained zero malaria status. We have come a long way from the 2006 Malaria Indicator Survey. When we started, Zambia’s national program was the National Malaria Control Centre; now, with the success against malaria seen over the last two decades, it is the National Malaria Elimination Centre.
As Dr. Campbell predicted, an “impressive series of meaningful successes” against malaria—even in the “hard places”—has shown us that a malaria-free Zambia is possible.
