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Fighting Malaria Requires Many Strategies
The huts in Zimbabwe’s Mbire district seemed to be a godsend. Guards huddled in them at night to protect valuable crops from wild animals. But there was a downside—and a big one. The more time people spent in the temporary shelters, the more exposed they were to malaria-carrying mosquitoes. The result: the district consistently ranked in the top 10 districts in the country for malaria burden.
But that is changing. Under the Zimbabwe Assistance Program in Malaria (ZAPIM) project, Abt Associates and our partners are combatting malaria alongside the Ministry of Health and Child Care (MOHCC). We facilitate the logistics for distribution of long-lasting insecticidal nets (LLINs) to complement indoor residual spraying (IRS). In addition, ZAPIM trained health workers at health facilities and village-based health workers to provide quality treatment for malaria. The Abt team also trained community mobilizers on effective messaging techniques and resources to prevent and treat malaria. The results of the five-year project in Mbire, funded by the President’s Malaria Initiative, have been significant. The number of cases dropped 43 percent, from a case incidence of 251 per 1,000 population in 2015 to 143 per 1,000 population in 2019.
How did Abt’s ZAPIM team achieve such success? The team worked with the Zimbabwean MOHCC National Malaria Control Program on a multi-pronged approach. ZAPIM implemented continuous LLIN distribution for use outdoors and in structures not suitable for IRS. The ZAPIM trained Health Centre Committees and made 55 temporary huts more substantial so that IRS would be effective. The Abt team mentored health staff and village health workers to improve case management. Electronic weekly reporting via phone improved the timeliness of reporting and decision-making by the district and the province. Data quality assessments by the district staff improved data quality, analysis, and use for decision making.
ZAPIM also strengthened social and behavior change communication (SBCC) through the community action cycle. The cycle includes community assessment of problems, development of an action plan, prioritizing actions, training the community, and empowering residents to solve their problems. The team trained Health Center Committee members to help educate people on proper use of interventions through the “My net, My life” campaign. As part of the SBCC effort, ZAPIM worked with Chapoto residents to produce and distribute an audio book in the Chikunda language. The tailored messaging resonated with the community, which helped disseminate the malaria information to those who could not read so that no one was left behind. The community changed its behavior significantly.
Monitoring, evaluation, and research provided insights into changes needed to make the programs more effective. The result was a marked reduction in malaria cases, especially in the four high-burdened health facilities in Chidodo, Masoka, Angwa, and Chapoto. The district has not experienced any outbreaks since 2018. Expansion of the practices to all the health facilities in Mbire could enable the district to move toward pre-elimination.
And no one is happier than the residents of Mbire. “My net, My life truly saved the lives of my people,” says Mr. Chisanhu, the village head of Chidodo.