The Crucial Role of Community Health Workers in the Fight Against Malaria in Zambia

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In Zambia, malaria has been a significant cause of illness and death. According to the 2022-2026 Zambia National Malaria Elimination Strategic Plan, Luapula Province ranked the highest in malaria prevalence at 63% in 2021, with Nchelenge District having the highest malaria prevalence in the region.

In order to increase access to care in rural areas, the country is scaling up training for community health workers (CHWs) to diagnose and treat community members through integrated community case management (iCCM). This strategy involves training, supporting, and equipping CHWs with the necessary knowledge, skills, and tools to provide diagnostic treatment and referral services for common illnesses, including malaria.

Zambia's goal is to train 40,000 community health workers (CHWs), with over 23,000 already ​​trained. The rationale behind this increase in the number of CHWs is to achieve a 1:500 saturation point: to deploy one CHW per 500 people in rural areas. This strategy also aims to ensure that all CHWs are actively engaged in their respective communities and equipped with the necessary resources and appropriate stock levels of malaria commodities. 

Despite the iCCM training, CHWs in Zambia were not able to provide malaria tests and treatment to their communities due to insufficient commodity supplies. As a result of bottlenecks in the supply chain, exacerbated by disruptions in shipments during COVID-19, there was an erratic distribution of malaria commodities such as rapid diagnostic test kits (RDTs) and artemisinin-based combination therapy (ACTs).

The U.S. President's Malaria Initiative (PMI) through GHSC-PSM worked with the Ministry of Health (MOH), Zambia Medicines and Medical Supplies Agency (ZAMMSA), and the District Health Offices (DHOs) to address this and ensure a more consistent supply of malaria commodities to communities that need them. 

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CHW Kasakula Godfrey explaining to community patient Chomba Karen about how to take her malaria treatment medication in Felushi Village under Kandeke zone of Kefulwa RHC catchment. Photo Credit: GHSC-PSM
CHW Kasakula Godfrey explaining to community patient Chomba Karen about how to take her malaria treatment medication in Felushi Village under Kandeke zone of Kefulwa RHC catchment. Photo Credit: GHSC-PSM
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CHW Kasakula Godfrey explaining to community patient Chomba Karen about how to take her malaria treatment medication in Felushi Village under Kandeke zone of Kefulwa RHC catchment. Photo Credit: GHSC-PSM
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GHSC-PSM facilitated an appeal to the provincial/district supervisors during the 2021 Regional Supply Chain Review Meeting (RSCRM) to ensure that an upward adjustment was made on approved order quantities of RDTs and ACTs. ​​In Nchelenge District, for example, this collaboration resulted in an improved provision of malaria supplies to CHWs and, consequently, an increase in iCCM activities at the community level. This in turn led to a rise in malaria case detection by CHWs, ​​from 79 cases in May 2021 to 5,366 cases by May 2023.

"The supply of malaria commodities for iCCM has really helped reduce malaria in our community, because when anyone develops a headache, fever and/or body pains they easily and quickly visit us (CHWs) and we detect and treat malaria early, unlike when they had to go long distances to the health facility," says Godfery Kasakula, a CHW in Nchelenge District.

The impact of the availability of malaria supplies on iCCM activities in the Nchelenge District is ​​demonstrated in the graph below, which presents data for the period between January 2020 and May 2023. 

  iCCM activity trend trends for Nchelenge District from 2020 to 2023 Source: NMEC

 

The ​​graph showcases the positive correlation between the availability of malaria supplies and the successful implementation of iCCM, contributing to a tangible reduction in reported malaria deaths from 10 deaths in May 2021 to 5 deaths in May 2023. This is according to data from the National Malaria Elimination Centre (NMEC).