Editor’s Note: Lesley Reed, a senior writer and editor at PATH, spent ten days in Zambia traveling with photographer Gabriel Bienczycki to cover PATH’s malaria prevention program. She brings this story to us.
What a difference ten years can make. When I traveled to Zambia in 2003, the hospitals were overflowing with feverish children delirious with malaria. The effects of the disease were debilitating for the entire country: mothers miscarried, fathers couldn’t farm or fish and their families went hungry, children—if they survived—missed weeks of school.
But not long after my visit, Zambia started an ambitious effort to defeat the disease. And on a return visit this past December, I found something entirely different: people everywhere talking about the end of malaria.
Malaria has never been eliminated in a sub-Saharan African country, but Zambia is leading the way. The effort is a sight to behold.
Don’t blame the mosquitoes
In 2004, PATH’s malaria program, Malaria Control and Elimination Partnership in Africa (MACEPA), set out to develop and prove a strategy that would bring down malaria rates fast. The strategy—rapidly scaling up the use of prevention methods like insecticide-treated bednets—had a dramatic impact in the southern tip of Zambia. From 2006 to 2013, Zambia reduced malaria deaths by 75 percent nationally.
Now PATH is working with the government of Zambia to develop and pilot strategies to eliminate the disease. To succeed, we need to stop the transmission of the malaria parasite from humans to mosquitoes (who then give it back to us).
Many people who carry the malaria parasite never go to a clinic, usually because they don’t have symptoms. “There is not yet a strategy to target those people,” says John Miller, senior technical advisor for MACEPA in Zambia. “We will never get rid of malaria if we can’t reach them.”
House to house
So PATH and the government of Zambia are piloting a groundbreaking approach in the country’s Southern Province—treating whole communities in a fell swoop.
Volunteer health workers travel from village to village, testing every member of every household. Whatever the results, everyone is given a three-day supply of drugs to kill any malaria parasite the test may not have detected, so that all infections are cleared even in people without symptoms. The drug also prevents new infections for a month. By then at least two generations of mosquitoes will have lived and died, reducing the chance of mosquito-to-human transmission.
Because we’re developing the science needed to eliminate malaria in sub-Saharan Africa, this is a three-arm clinical trial. In some villages, only those who live in a household where at least one member has tested positive are treated. People in control villages receive standard malaria prevention methods, but only those with clinical symptoms will receive treatment.
A people united
So how do you convince entire communities to take drugs for a disease they might not realize they have?
One key strategy is to engage all local leader styles. Traditional chiefs, teachers, ministers, women’s groups, fishermen’s associations, and more are educating their constituents and leading by example.
As a result, “No one is refusing the program,” Rachel Mokosha, the malaria focal person for the district of Choma, told me. “They see the results themselves.”
Another strategy is enlisting volunteer health workers and data collectors, who are selected by their villages and know their culture, to be the face of the program. In return for their long days of work, they gain valuable skills and make a tangible difference in their communities. Their determination and optimism was truly inspiring.
Put these and other elements together and you have a massive effort. But it’s clearly worth it to all involved if it will end a disease that has hobbled a continent for time immemorial.
“No one else is doing this in Africa on this scale yet” says John Miller. “PATH is working with Zambia’s health ministries to generate the evidence and lead the innovation. The country is taking local ownership. The effort has its own momentum.”
This post is part of Mapping the Journey, a multi-part series which explores how PATH turns ideas into solutions that bring equity, dignity, and health to women, children, and families worldwide.
- Lesley Reed is a senior content officer at PATH.