Author: Young, M.
It is clear that malaria is a major public health problem in Zambia and it has been increasing in prevalence and severity over the part decade. Part of this increasing burden is due to the growing resistance of the parasite to the standard chloroquine treatment. The Roll Back Malaria (RBM) initiative has gained widespread political support in the region, including the Government of Zambia. There is support at the government level for the RBM process, plus a willingness and desire to improve malaria control activities.
The goal of the present consultancy is to provide technical input to key areas of the malaria programme in Zambia in order to assist with a scaling up of activities and operationalization of the National Roll Back Malaria strategy. The objective is to support the detailed action planning process of the National Roll Back Malaria strategy in collaboration with key partners in Zambia, most importantly the National Malaria Control Centre (NMCC), the Central Board of Health (CBoH), World Health Organisation (WHO) and United States Agency for International Development (USAID), and make recommendations that will facilitate and improve the existing planning process. Priority areas include scaling up of both the Insecticide Treated Net (ITN) component and integrated management of childhood illness (IMCI), changing the antimalarial drug policy, capacity building, advocacy and information, education and communication (IEC).
The activities undertaken included:
Findings and Conclusions:
The challenges for planning and operationalizing a National Malaria Control strategy in Zambia are clear. At the central level, there is a tremendous amount of capacity and technical resources available, spearheaded by the National Malaria Control Centre (NMCC) and a multi-sectoral malaria working group. This partnership seems to be working well at the central level, with representation from a wide range of ministries, organizations and agencies. There is a need, however, for more emphasis on ’partnerships‘ at the district and community levels. First and foremost, there is a need to establish strong public-private partnerships and a multi-sectoral coordinating body for the RBM activities at the district level, as this will impact strongly on all other planning and implementing processes of RBM.
There should be increased efforts at community IEC and communication for behaviour change with regard to ITNs, utilizing multiple media (including traditional media), and targeting vulnerable groups with subsidized ITNs through a voucher system. Limited vector control strategies should be utilized in selected areas, with support from the private sector. Key IEC messages have been developed, but these now need to be disseminated widely along with the development and distribution of appropriate materials and teaching aids for health workers and volunteers.
Chloroquine resistance is worsening and there is a critical need to change the first-line drug treatment for malaria in order to improve clinical management, with sulphadoxine-pyrimethamine (SP) appearing to hold the greatest promise. There is a need to intensify efforts at intermittent presumptive treatment during pregnancy, using SP, and integrating antenatal services in the areas of malaria control, HIV/AIDS and nutrition.
Training of health workers in the integrated management of childhood illness (IMCI) is encouraged and this is especially vital in terms of community-based IMCI training for community health workers (CHWs) along with the provision of drug kits. There is a need to bring the treatment of malaria as close as possible to the community, and linking this to an integrated health intervention like IMCI is to be encouraged. The national and district-level drug procurement system will require strengthening, and perhaps could go hand in hand with a change in national drug policy. Steps should be taken towards ensuring that hospitals and larger health centres have functioning, quality-controlled laboratories, whereas consideration should be given to providing rapid malaria diagnostic test kits for use at rural health centres, in order to improve case management and decrease the overuse of malaria drug treatment.
There is a need to integrate malaria with nutrition activities at the district and community levels and this is particularly important for the provision of micronutrient supplementation (iron, folic acid, vitamin A, zinc) in combination with SP presumptive treatment for women during pregnancy. The key malaria indicators that are presently included in the health management information system (HMIS) should be supplemented with information from sentinel surveillance sites. The key indictors necessary for effective monitoring of country-wide RBM activities are listed. Further work at coordinating priority research efforts should be undertaken.
The human resource and capacity-building needs are well articulated in the Ministry of Health 5-Year Plan. The operationalization of this plan should be supported as it will strengthen RBM activities. There needs to be a concerted effort to train community health workers (CHWs) and provide them with the necessary skills and logistics as they will be the driving force behind the malaria control activities in the long term. Also, there needs to be a strong, competent district administration and coordinating body for RBM activites.
The overall RBM plan for Zambia needs support from the government of Zambia and the cooperating partners in order to succeed. UNICEF Zambia can support efforts in all of these key areas and build on their current strength of community-based participatory action, as this is the key to success for Roll Back Malaria.
Specific recommendations are given in the report for the areas of: Insecticide Treated Nets; Vector Control; Information, Education and Communication; Epidemic Preparedness; Clinical Management and Intermittent Presumptive Treatment; Drug Supply; Laboratory Services; Malaria and Nutrition; Monitoring and Evaluation; Research; and Human Resources and Capacity Building.
General recommendations for the Central Level are:
General recommendation for the District/Community Level:
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Health - Malaria
National Malaria Control Centre (NMCC), Central Board of Health (CBoH), WHO, USAID