Community health workers practicing using rapid diagnostic tests for malaria
Lake Kariba in southern Zambia is absolutely stunning. The world’s largest artificial reservoir is rich with fish, birds, crocodiles, hippos, and islands—and the lake’s shoreline town of Siavonga boasts a thriving tourism business. This beautiful area is also a breeding ground for the mosquitoes that carry malaria and is on the front lines of the Zambian government’s efforts to combat the disease.
When I met with Zambian Minister of Health Dr. Joseph Kasonde, he emphasized that the goal is not a “malaria-free Zambia” but malaria-free Zambians—stopping transmission of the disease by targeting the malaria parasite reservoir in humans. PATH is tackling malaria on many fronts, including improved drugs, diagnostics, vaccines, and systems. Key to this work is building evidence to support broad-scale use of these new innovations.
At Lake Kariba, I met more than 50 community health workers, participants in a PATH-led training session, who are helping to reduce malaria in the country’s Southern Province. These men and women hike—sometimes as far as 12 miles—into hilly regions that are often inaccessible by vehicles to test and treat people and ensure they have preventative measures like insecticide-treated bednets. Such remote areas often are the “hot spots,” the breeding grounds that contribute to the spread of malaria.
“Malaria is a killer disease,” said Marie Antoinette Musanabera, a trainer from the Ministry of Health who attended the workshop. “For us to bring services closer to the community—to bring services to their doorstep—that is how you break the chain of malaria.”
Community health workers are the heroes of global health, and they have been instrumental in making Zambia a malaria success story. Health facilities reported a 66 percent decline in the number of malaria deaths from 2000 to 2009; the drop was especially steep after distribution of 3.6 million long-lasting insecticidal bednets between 2006 and 2008. During this period, parasite prevalence declined 53 percent nationwide. In recognition of the country’s achievements, in 2013 the United Nations awarded Zambia the African Leaders Malaria Alliance Award.
The Zambian government has set a goal of near-zero deaths and five malaria-free districts by 2016, and PATH is playing a lead role in supporting the country’s efforts. Our approach builds on successful methods (such as using bednets, insecticide spraying, strengthening surveillance and data reporting, and testing and treating). We also pilot new tools and strategies, such as proactively providing drugs that halt malaria transmission by killing the parasite even if someone is not showing symptoms and which temporarily prevent people from being reinfected. The lessons learned from PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) program in Zambia and three other countries (Ethiopia, Kenya, and Senegal) will inform subsequent adaption and adoption of these methods across Africa.
The Siavonga residents shared with me the impact they’ve seen from the collaboration to reduce malaria in Southern Province.
“During the times of peak months (rainy season), we used to have a lot of people in the hospital,” said Florence Namwanza, a mother of six, who described her bouts with the disease and its symptoms of sweating, vomiting, fever, and backache. “Now, there are not so many.”
The district representative emphasized the large-scale implications of this effort. “Once malaria is controlled, the outlook of people’s lives will be better,” said Dr. Phallon Mwaba. “They will be more productive in fishing and farming. It may look today like we are just trying to control malaria but, ultimately, it will affect the economic status of the people.”
Malaria is estimated to cost Africans $12 billion a year, including the cost of health care, days off school and work, decreased productivity, and loss of investment and tourism. The disease kills an estimated 630,000 people a year, most of them African children.
The good news is that increased prevention and control measures have led to a reduction in malaria mortality rates by 42% globally since 2000. During this period, PATH has made tremendous strides in research and development for new tools and in partnering with governments to scale up malaria prevention and control. Across PATH, more than $79 million is committed to malaria activities this year alone, and our portfolio of malaria programs and projects includes more than 125 staff members.
Globally, there is growing interest in finding new tools and approaches to reduce the burden of malaria and to accelerate progress towards the goal of eradication. Because of its remarkable progress, Southern Province offers a good test case for elimination. Once methods are proven successful there, they can be scaled up to the rest of the country. If successful in its quest, Zambia would be the first country in sub-Saharan Africa to achieve this transformation.
Some of the men and women I met at Lake Kariba have been doing this work for decades—and their hard work and commitment is paying off. Seeing their dedication and that of the government representatives renewed my conviction that that, together, we can turn the tide.
One of the trainers summed it up like this: “The major reason we are here is to actively detect malaria parasites in people and treat them, to ensure that we have cleared them, in the hope and belief that one day we will be free of malaria.”