Bringing health care closer to the people–How community health workers are proving to be the key to eliminating malaria.

By Tigana Chileshe, Communications manager

According to the World Health Organization (WHO), Zambia has a doctor-patient ratio of one doctor for every 12,000 patients, which is below the WHO's acceptable standard of one physician for every 5,000 people.

While the Zambian government is striving to solve the problem, underprivileged and marginalized communities are often the ones who suffer the most.

When one is unwell, death is merely a stone's throw away due to a lack of health personnel and medical facilities; even in treatable diseases like malaria, one of the leading causes of mortality in the Sub-Saharan African country.

With fewer medical facilities and medical personnel to attend to sick people in most remote communities, many have to travel long distances in search of help on foot some are lucky on bicycles and motorcycles.

In the case of Sanga village,  a rural settlement in the Eastern province of Zambia, the nearest health post named  Mutilizi Health post is 13 kilometers away. A nightmare walk on sick and weak limbs.

During the rainy season and following heavy rains, Sanga village is cut off from Mutilizi Health post by floods. It is also during this time that malaria cases increase. This is because more of the mosquitoes breed in waterlogged and damp places.

“When it starts to rain, you pray that you do not get sick of malaria because there will be no one to help you,” says Mark Tembo, 47, a resident of Sanga, who has his experiences of having to attend funerals of people who died because they could not get help in time after following ill.

Zambia is among the 20 countries with the highest malaria incidence and mortality globally.  The country carries 2% of the global malaria case burden and 5.2% of the case burden in East and Southern AfrMalaria responsible for 50% of all infant deaths and 20% of all maternal deaths in Zambia.  That is 50,000 deaths per year according to World Health Organization, making Zambia one of the  20 countries with the highest malaria incidence and mortality globally.

While efforts to control, prevent, and eliminate malaria have intensified in the past two decades in Zambia which has contributed to reductions in malaria prevalence and under-five mortality. However, in a place like Sanga, malaria is still a major cause of death.

“There was a case of a child who died from malaria because they did not reach the clinic in time due to the flooded stream. By the time they go here(Mutilizi Health post) it was already late,” says Daniel Muchoni, Nurse In-charge at Mutilizi health post.

Meeting the gap through community health workers

Samilani Mwanza, 30, a community health worker, is seated on a wooden chair outside his house, with a medical records book in his hands; usually, he would have gone around the village to check on his patients.

But, today, he is tabulating the number of people he tested for malaria in October. A name written in red means, a positive malaria test, while one written in blue means a negative malaria result test.

“I have no medications left, so while I wait on the clinic to give me some more, I need to take an inventory of the ones I received and distributed them against the number of people who were sick in this zone,” he says.

Samilani will later travel 13 kilometers with a bicycle to take the data to Mutilizi medical health post. These numbers will feed into records used to treat and eliminate malaria in the area.

Samilani is a trained Community Health Worker working under a model known as Integrated Community Case Management (iCCM) trained by World Vision.

Integrated Community Case Management (iCCM) is a model developed by World Vision to train, support, and supply community health workers to provide diagnostics and treatment for multiple illnesses, specifically pneumonia, diarrhea, and malaria.

The model targets sick children of families who have difficulties in accessing health services at health facilities.

In 2019, with support from World Vision, the District Health Office trained Samilani and other community members in iCCM under the Nyimba under the Nyimba Village transformation project.

The community health workers were trained to identify and treat malaria, and diarrhea, and pneumonia. Since the training, Samilani says he has helped nearly 200 people every month in his zone.

“The community health workers are helping meet the need in communities where health centres are far,” says  Vincent Siwale, an expert in Maternal, Newborn, Child Health Nutrition and Promotion working for World Vision in Nyimba Area Program.

“Community health workers are also helping reduce the conjunction in rural health centres, as most malaria and diarrhea cases are treated at home only severe cases are brought to the clinic,” he says.

Mark Tembo, 46, with his wife and two children, were tested and found with malaria and later treated by Samilani.

“Samilani visited our home when I was unwell; he tested me for malaria and my family. We were found to be malaria positive, and he put us on treatment,” he says, “ At the time he came to our house, it really helped us before the malaria became severe, especially for my children.”

The presence of Community health volunteers like Samilani through iCCM has become the bedrock of hard-to-reach communities as they bring curative health care to children in those communities.

“Once one member tests positive for malaria, the entire household is tested; in many cases, other members in that house are also found to be positive,” says Daniel Machoni, Nurse In-charge at Mutilizi Health post.

“This method helps provide critical early treatment and also reduced congestion at the health post, as community health workers supplement our efforts,”  he says. “I, therefore applaud World Vision for supporting us through iCCM; it is really helping us combat malaria in our catchment area through early diagnosis and treatment.”

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On March 9th, 2021, Rotary International, World Vision, and the Bill & Melinda Gates Foundation announced the launch of Rotary’s first Program of Scale, Partners for a Malaria-Free Zambia, a $6 million investment to train, equip and deploy 2,500 Community Health Workers in Zambia. Partners for a Malaria-Free Zambia will strengthen the national health system by working closely with local health officials and health facility staff, scaling up Rotary’s successful work in the Copperbelt Province to reduce malaria by 90% in two additional Zambian provinces.