Lessons learned in Rotary’s fight against malaria in Zambia

Ruth, a community health worker, demonstrates how she tests patients for malaria. Central Province, Zambia. 26 August 2022.

By Axel von Bierbrauer, The Rotary Foundation Cadre Technical Adviser, and member of the Rotary Club Neunkirchen/Saar, Germany

Najuma (29) lives with her three-year-old daughter Alika and two other children in a small home in a village near Mpika, in Zambia’s northeastern Muchinga province, 650 km from the capital Lusaka. The rural province is one of Zambia’s least developed regions; most people live from small-scale agriculture, and unemployment is high. Najuma herself had a severe malaria episode during a pregnancy, which she barely survived; two of her formerly five children died of malaria in infancy.

Malaria is still one of the most common and threatening infectious diseases worldwide, with over 220 million cases each year. Over 400,000 people die from malaria worldwide each year (WHO 2019), 94% of these fatalities occur in Africa. The poor in rural areas are disproportionately affected, especially children under five and pregnant women. Malaria is responsible for 50% of child mortality and 20% of pregnancy deaths in these areas.

I met Najuma in July 2022 during a visit to the Partners for a Malaria-Free Zambia program as a Technical Adviser for The Rotary Foundation Cadre. Najuma had been working as a community health worker in malaria control for eight months. She is responsible for over 500 people in her neighborhood. To become certified to work in this capacity,  Najuma received training with 30 new fellow community health workers in all the important factors of malaria prevention and control. She proudly tells me that she received her certificate of completion and was one of the top three course participants at the end of the exhausting training week.

Community health workers at the certification ceremony for the Partners for a Malaria-Free Zambia program

The training and Najuma’s work are funded by the first winning project of the new Programs-of-Scale Grant offered by The Rotary Foundation, awarded in 2020. Together with World Vision and the Bill and Melinda Gates Foundation, dedicated Rotarians are working to fight malaria in hard-hit areas in Zambia through this US$6 million grant. This initiative in Zambia was started 10 years ago by a Seattle Rotarian group led by Bill Feldt, who also leads this groundbreaking project today.

Najuma has an entire backpack with malaria equipment and goes from hut to hut to inquire about the health of the inhabitants. If someone has a fever or other malaria symptoms, she carries out a rapid test directly on-site. If the test is positive, she immediately administers the malaria medication, which the patient must take for a few days. In this way, the therapy now reaches the patient, who previously had to actively seek treatment themselves – which often did not happen. Najuma also knows the warning symptoms of a severe malaria episode, especially in young children. In life-threatening cases, she arranges for prompt transport to the associated Health Facility Center (HFC).

Najuma enters each visit into an application on her phone, provided through the project, noting whether she performed tests, dispensed medications, or referred someone to an HFC. The app has been programmed especially for the project (freeware) and enables timely documentation and control of the project progress while providing an immediate overview of the consumed – and therefore needed – project resources. This is of immense importance for maintaining the supply chain of malaria tests and treatments as this is often a critical challenge for malaria elimination projects.

Once a month, a community health worker group meeting is held at the local HFC where the project data accumulated electronically is checked, verified and, if not already done, forwarded to the project management. At this meeting, Najuma also receives the necessary rapid tests and medications for her work in the community through the project.

Community health workers receive malaria equipment at a health facility center

“I love my work as a community health worker. Through the training, my reputation in the community has increased and I can help every day small children like my Alika no longer die of malaria and help prevent pregnant women from becoming as seriously ill as I once was” says Najuma happily at the end of our visit.

Lessons learned

The site visit to the Partners for a Malaria-Free Zambia program provided me with valuable lessons that can be of use to others working on Disease Prevention and Treatment projects. These are:

– Consistently trained and supported community health workers are ideal for closing medical supply gaps, especially in rural underdeveloped regions of the world.

– The principle “The treatment comes to the patient” instead of “The patient has to travel long distances for treatment” ensures that potentially life-threatening diseases are controlled in a timely manner.

– The intelligent use of modern information technology, here using the example of the malaria reporting app developed specifically for the project, enables efficient project management to ensure timely reporting of cases and malaria commodity supply needs.

– Through continuous and shared learning, a powerful, large-volume project can be developed from the experience of implementing, monitoring, and evaluating prior smaller local projects.

If you have questions or need technical advice for building up similar projects dealing with malaria control or other healthcare topics, please do not hesitate to contact The Rotary Foundation Technical Cadre or Rotarians Against Malaria – Global Rotary Action Group. For more information on Rotary’s Programs of Scale awardee Partners for a Malaria-Free Zambia, please contact Martha Lungu, Rotary member and Executive Director of the implementing committee for the program, at info@malariapartners.org. Watch this video to learn about Martha’s personal experience with malaria:

Read about how Rotary’s Programs of Scale award, Partners for a Malaria-Free Zambia, confronts a worldwide malady at the local level.

View this program’s theory of change and its year 1 progress report.

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