- Zambia alone reported over 7 million cases of malaria in 2021
MAYENGO NYIRENDA
Kigali, Rwanda
MALARIA remains a major global health burden, worsened by the COVID-19 pandemic.
Africa bears 95 percent of malaria-related deaths, with Zambia being a highly endemic country.
According to the World Health Organisation (WHO), malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.
In a bid to support member States in introducing and scaling up malaria vaccines, in January 2024, WHO regional office for Africa established the Accelerating Malaria Vaccine Introduction and Rollout in Africa (AMVIRA) initiative.
Seventeen countries in Africa, with roughly 70 percent of the global malaria burden now offer malaria vaccines sub-nationally through their routine childhood immunisation programmes.
Since 2023, over 12 million vaccine doses co-funded by Gavi, the Vaccine Alliance, and countries have been procured and delivered by UNICEF to these countries.
Fourteen of these countries introduced the vaccines for the first time in 2024, including Cameroon, Burkina Faso, Sierra Leone, Benin, Liberia, Côte d’Ivoire, South Sudan, Mozambique, Central African Republic, Niger, Chad, Democratic Republic of Congo, Sudan, and Nigeria.
An additional eight countries are forecast to introduce the malaria vaccine into their childhood immunisation programmes in 2025, and 13 have secured Gavi support to scale up their national programmes to reach more children in the coming years.
The first malaria vaccine was recommended by WHO in 2021 to prevent the disease in children after the success of the malaria Vaccine Implementation Programme (MVIP) in Ghana and Kenya.
In 2021, Zambia alone reported over seven million cases of malaria, with rural populations being at a 4.5 times risk than urban areas.
And according to National malaria Elimination Centre (NMEC), on average, there are an estimated 20,000 cases of malaria per day in Zambia, and each day, an average of four
Zambians die from the killer disease.
In addressing this alarming trend, experts and health professionals gathered at a three-day Africa Health Agenda International Conference (AHAIC) in Kigali early this month to discuss a number of health issues, among them, the need to scale up malaria vaccination across different countries in Africa, among other interventions.
Back home, Zambia aims to eliminate Malaria by 2030, with three provinces (Southern, Lusaka and Central) having already reached pre-elimination levels.
Government, through the Ministry of Health and the NMEC, is also committed to eliminate malaria by 2030, focusing on a coordinated and collaborative approach, including vector control, case management, and community engagement.
Minister of Health Elijah Muchima says Government is working with other cooperating partners and neighbouring countries to end malaria by 2030.
“It is the desire of this Government that by 2030 we end malaria. It is our number one agenda in the ministry, working together with other countries because we cannot just deal with it in Zambia. You have also to go to the neighbours collectively,” Dr Muchima said.
Amref Health Africa in Zambia is implementing a three-year project called ‘Primary Health Care for malaria Elimination’ (PHC for ME).
The aim of the project is to strengthen primary health care systems in Luapula, Muchinga, and Northern provinces and also improve malaria diagnosis, treatment, prevention, and surveillance.
Under this project, Amref Health Africa Zambia’s office trained 1,000 community-based volunteers in Integrated Community Case Management (ICCM) and Social and Behaviour Change Communication (SBCC).
Under the same project, Amref Health Africa Zambia office also conducted one Technical Support Supervision (TSS) activity in Mansa.
Amref Health Africa Zambia’s office also distributed bicycles in Mansa, Mungwi, Chilubi, and Mpika to support community health workers involved in the malaria response.
The distributed bicycles were bought by GSK, one of the cooperating partners in this project.
Community health workers (CHWs) act as an important part of the Zambian government’s malaria elimination strategy.
CHWs are an extension of health facilities, reaching into surrounding communities to provide health education and basic services.
They also serve as malaria agents, lay counsellors, treatment supporters, safe motherhood action group members, and community-based distributors.
Further, they support the national policy that every Zambian should have equity of access to cost-effective, quality healthcare services close to their home.
Idah Mumba, from Mansa district, Luapula Province, is one of the 1,000 CHWs who have been trained and supported with the bicycles for implementation of their work in communities.
Speaking during the AHIC in Kigali, Ms Mumba disclosed that she serves 224 households in her community in providing malaria tests, family planning, and maternal health support.
“My coverage community has 987 people. The long distances were my biggest challenge.
However, with a bicycle, I can now reach more families and deliver care on time,” Ms Mumba said.
She stressed that early diagnosis and treatment of malaria helps prevent local transmission of the disease and stop the progression of malaria cases from uncomplicated to complicated forms that can be fatal.
Ms Mumba, who has been a community health worker since 2019, thanked Amref for its support in providing a bicycle which has enhanced her service delivery, visiting more households and improve community health.
Her daily activities include administering malaria Rapid Diagnostic Test (RDTs) and giving anti-malarial medication to those who test positive in her community.
She also contributes to providing health education on other malaria interventions to the community.
Ms Mumba travels about five to seven kilometres each week on the bicycle she recently received from Amref to easily reach the people in need, without having to endure long hours of walking.
During the same conference, Anthony Gitau, Johnson and Johnson’s director of programme delivery and impact for Africa and the Middle East, stressed the importance of investing in community health to deliver universal health coverage (UHC).
He underscored the urgency of using limited resources efficiently, given the global shortage of six million health workers, two million of whom are CHWs.
Centre for Diseases Control-Africa representative Landry Dongmo Tsague commended CHWs’ dedication and emphasised the importance of investing in resilient health systems, particularly after the COVID-19 pandemic.
He called for mobilisation of domestic resources to be used to train, equip, digitise, and remunerate CHWs in Africa.
“We must invest in community health workers as the primary health workforce.
“We should not consider the CH as a second-class workforce, but rather, as a front-line workforce,” Dr Landry Dongmo said.
According to World Bicycle Relief, in Zambia, CHWs equipped with bicycles reported a 63 percent increase in productivity, enabling them to reach more patients and improve maternal and child health outcomes.
World Bicycle Relief representative Maureen Kolenyo detailed the impact of bicycle solutions on CHW productivity, noting that her organisation has distributed over 868,000 bicycles.
“Bicycles are affordable, efficient, have low impact on the environment and are easy to use. We have insurmountable evidence to show that they transform health care delivery.
A study in Zambia showed a 63 percent increase in service delivery where CHWs had bicycles. That’s the power of mobility,” Ms Kolenyo said.
Amref Health Africa group chief executive officer Githinji Gitahi urged African leaders and global stakeholders to rethink health investments to build resilient and sustainable health systems.
Dr Gitahi underlined that Africa’s economic and population growth challenges are deeply linked to healthcare financing.
“Sub-Saharan Africa is facing an economic crisis, and the lack of fiscal space is a major issue.
Investing in health must be tied to population development, ensuring that every girl and woman has the right to make informed reproductive health choices,” he said.
Dr Gitahi called for investment shifts towards Primary Health Care (PHC), warning that disproportionate funding for tertiary care leaves millions without access to essential services.
He notes that Amref had significant programmes worth about US$28 million in Kenya, Malawi, Zambia, Ethiopia, that were being sponsored by USAID, and that the core of these programmes was around maternal and child health, preventing mother to child HIV transmission. “So, as we speak, we are working with the governments to ensure that no child is going to be exposed to HIV because they were not protected during the mother’s pregnancy.
That’s a risk.
“We had programmes on HIV prevention testing, for example, we had programmes on what you may call running care treatment centres for HIV, what we call the comprehensive care clinics that have stopped,” he said.
Dr Gitahi said Amref had health workers across Zambia, Malawi, Ethiopia and Kenya, among other countries, that were actively involved in care and treatment for prevention of mother to child HIV and tuberculosis transmission, care and prevention that are out of the health system, though they are still trained.
