Bill & Melinda Gates Foundation

Going Local: Community Health Workers at the Forefront of Zambia’s Malaria Fight

September 18, 2012

Even on paper, the task is daunting – going to remote places in Zambia where malaria affects people the most and testing every man, woman, and child for the disease. The goal of this effort is to find and treat all those carrying the malaria parasite before the rains begin in December, signaling the start of another transmission season. Testing entire villages is an enormous logistical challenge, but because a significant number of people infected with malaria do not know they carry the disease or show any symptoms, this mass “test and treat” approach is critical to clearing pockets of persistent infection in the country and reducing malaria illnesses and deaths.

It’s the first time something like this has been attempted, and it is part of Zambia’s three-step plan to establish large malaria-free zones in the country by 2015. And all three steps rely heavily on Zambia’s network of community health workers – the backbone of Zambia’s rural health system. How does this work? First, weekly reports of confirmed malaria cases are sent via cell phone to a centralized server, establishing a baseline and identifying areas where malaria transmission is high. Then mass test and treat is conducted to rid those areas of parasites. And finally, once transmission is low, an active surveillance system is implemented to investigate any remaining cases that may turn up, preventing new outbreaks from occurring.

In a typical day during a malaria test and treat campaign, a health worker can cover up to 20 kilometers by foot, traveling the maze of dirt footpaths that connect rural houses. What makes these workers unique is that they are volunteers elected by their communities, many of whom have been in their positions for a decade or longer. Most feel deeply invested in the health of their communities and have gone to great lengths to ensure that their work is carried out – sometimes sleeping out in the bush, staying up all night to fix broken equipment, even wading across chest-deep flood waters with their medicines and supplies carried above their heads. The dedication of community health workers, their access to remote areas, and their intimate knowledge of rural communities and their residents are critical to reducing malaria burden in the country.

As Zambia’s test and treat activities come to a close for the season, many communities will have lowered the malaria burden enough to move into the next phase of fighting the disease – greatly improving the health of families and putting those communities on the path to becoming permanently malaria-free.

 
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