May 9, 2016 |

Zambia’s bold ambition: zero malaria by 2020

Here's how the country plans to be the first in sub-Saharan Africa to eliminate malaria.
Two African somen standing in front of a water tower, one wearing a 'Test 4 Life' smock.
In Zambia, community health workers, community members, and leaders are joining forces with the Ministry of Health to end malaria by 2020. Photo: PATH/Gabe Bienczycki.

Editor’s note: Post author Nanthalile Mugala, PATH’s program leader in Zambia, is speaking about Zambia’s efforts to eliminate malaria at PATH’s Breakfast for Global Health, which will be held on May 10 in Bellevue, Washington, and May 13 in Seattle.

My country, Zambia, is about to release a bold plan to eliminate malaria by 2020—and I could not be more proud or excited. If successful, Zambia could be one of the first countries in sub-Saharan Africa, if not the first, to eliminate the disease from within its borders. In the process, we will have set down a roadmap for other countries to follow.

Zambia declared its ambitious goal last year. The “zambitious” statement came from the minister of health, Dr. Joseph Kasonde, a leader who is now fond of saying to health officials, “Eliminate malaria or be eliminated.” We have learned not to doubt the political will of our primary partner in Zambia.

Becoming a leader

Zambia welcomed PATH more than a decade ago to address one of the country’s leading killers of young children—malaria. While PATH now also tackles other critical areas of health, malaria remains the heartbeat of the relationship.

It’s not an easy place to confront the malaria parasite. Imagine a country as big as Texas but with half the number of people spread across some very difficult-to-reach places. But early in the partnership, it became evident that Zambia was extremely serious about fighting the disease.

A group of people holding folded bednets over their heads.
Zambia made its first push to drive out malaria a decade ago with widespread distribution of insecticide-treated bednets and other prevention tools. Photo: PATH/Paul Libiszowski.

While most countries were pursuing localized strategies, Zambia decided to take malaria control interventions—bednets, insecticides, diagnostics, and drugs—nationwide.

There were critics doubting that a campaign this big could succeed. So to be sure the strategy was working, Zambia needed to measure progress. That meant, for the first time, a national malaria survey.

With PATH support, the country has now conducted five of these surveys, collecting vital information on the number of children carrying the parasite, on pregnant mothers accessing preventive medicine, on the number of bednets provided and how many of them are actually being used, and more.

It may sound simple, but this started a data revolution in malaria control. And Zambia was able to show a return for its boldness: in just two years, the number of children infected with malaria fell by half. From that moment, Zambia was recognized as a leader in controlling malaria.

The living laboratory

Not satisfied with incremental progress, Zambia decided to take an even more aggressive approach. The aim was to shrink the malaria parasite reservoir, that is, the number of humans who have the parasite in their blood. The majority of people with the parasite don’t have symptoms, but if a mosquito bites them and then bites someone else, they spread the disease.

Through PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA), we helped Zambia set up a rapid reporting system in one-third of the country’s health facilities to provide near real-time data on malaria cases and available supplies. With the data submitted by mobile phone, health officials no longer have to wait months for the information to wind its way, on paper, through the health system.

Slideshow on malaria.
View this slideshow to meet some of the inspiring Zambians who are eliminating malaria in their country. Photo: PATH/Gabriel Bienczycki.

Then we reached 50 years back into an earlier effort at malaria elimination and pulled out MDA—mass drug administration for malaria. As its name implies, MDA involves giving treatment to a lot of people. Zambia’s Southern Province stepped up to serve as a laboratory.

Malaria MDA the Zambian way meant that for the first round, over the course of one intense month, community health workers went village to village, house to house, and treated 102,477 people.

The results of the MDA study—comprised of four rounds, concluding two months ago—are being written up as I type this. I can report that they’re very promising, and likely a huge reason why Zambia’s most recent national survey recorded a dramatic 93 percent drop in malaria parasites in children in Southern Province.

Going nationwide

So what’s next? In September, MDA will expand in Southern Province, reaching an estimated quarter of a million Zambians. Wherever MDA has knocked down the malaria parasite to low levels, community health workers are responding to any outbreaks with door-to-door action.

Next we’ll be supporting Zambia to bring MDA to Western Province. Meanwhile, in parts of the country where malaria rates are still high, PATH’s newest malaria project, the Program for the Advancement of Malaria Outcomes (PAMO), will apply the lessons we’ve learned from our decade of support to accelerate progress.

An African health worker pricks the finger of a child for a blood test for malaria.
PATH and Zambia are working together to introduce a more sensitive rapid diagnostic tests to detect low-level malaria infections. Photo: PATH/Gabe Bienczycki.

We’ll also continue to back innovation. With our support, scientists at the national malaria program are extracting DNA from parasites in mosquitoes to better understand disease transmission patterns. And later this month, PATH begins work with the ministry to introduce a more sensitive rapid test to detect hidden malaria parasites.

Until malaria is history

Next year we hope to stand side-by-side with Zambia’s Ministry of Health to celebrate the creation of the country’s first malaria-free zone. Soon we may face new challenges: selling the sustained effort required to get to a malaria-free population when it’s no longer mathematically possible to demonstrate massive impact.

Zambia’s dramatic reductions in malaria may also cause donors to turn their attention and investments elsewhere, believing that malaria is no longer a problem. But malaria will continue to be a problem for this planet until it’s gone.

I’m proud to work at PATH and to partner with a country—my country!—that backs up bold statements with actions. I plan on seeing my country free from malaria, dispatching the disease to the dustbin together with smallpox and, hopefully soon, polio. I can imagine no greater gift for our children.

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