Community health workers: The backbone of malaria elimination

April 25, 2019 by Chelsea Montes De Oca

Mubita Dickson, CHW in Zambia's Southern Province

Fewer than a dozen cases of malaria were recorded in the last year at the health center where community health worker Mubita Dickson is based. Photo: PATH/Chelsea Montes de Oca.

More than 1600 volunteers in Southern Province, Zambia are saving lives and accelerating the country toward a malaria-free future.

Imagine having to walk more than a half marathon to receive medical care. This is the reality for Mubita Dickson and others in his village in Zambia, who must travel 17 miles to reach the nearest health facility. Ten years ago, Mubita recognized the negative impact this had on his community and signed up to be a community health worker.

“Three years ago, I witnessed a baby die from malaria,” Mubita said. “I wanted to help people in my community because they have challenges reaching the health facility.”

The closest health facility to Mubita’s village is Kabuyu Health Center in Kazungula District in Zambia’s Southern Province, about a 30-minute drive from one of the Seven Natural Wonders of the World, Victoria Falls. Yet the true wonder in this region is how this health center has managed to record less than a dozen cases of malaria in the last year — most of those cases imported from other parts of Zambia. The secret to this success are community health workers like Mubita.

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Each month, Edson Phiri, a data community health worker in Southern Province, collects hard copies of malaria records from fellow CHWs in his district and reports the data into the electronic system, via an Android app. Photo: PATH/Cassi Flint

Chasing down every last malaria parasite

Community health workers are nominated by their own communities to provide health care at the household level. They are trained to test and treat for malaria, as well as two other major killers—diarrhea and respiratory infection—and equipped with life-saving medication. These individuals receive a modest set of incentives after their initial training—a bike, talk time (data health workers also receive a cell phone), and a t-shirt and apron. However, these volunteers receive no ongoing monetary compensation for their work. Many raise crops or livestock as a source of income on top of their work as a health worker.

“I do not get any support materially from the community but they appreciate the community health worker program because it is yielding fruit in saving lives,” Mubita explained.

Community health workers also help track cases of malaria in their communities and at the local health posts using a pre-programmed cell phone. This information aids the Ministry of Health in building a timely, accurate database to help drive informed strategies for elimination. It also allows us to build tools to better visualize malaria and track our progress.

Today, there are more than 1,600 community health workers in Southern Province, collectively managing over 60 percent of malaria cases. This not only drives down the disease but frees up health facility staff to focus on other health issues. Kabuyu Health Center is not alone in reducing malaria cases to near non-existent levels and saving lives. In the past year, Siakasipa health post, a facility serving neighboring communities in Kazungula District, recorded zero local cases of malaria.

This is not to say Southern Province still doesn’t face challenges related to malaria. While much of the province has seen a drastic drop in malaria cases due to increased community surveillance, parts of the region are still struggling to eliminate the disease. Florist Simoonga, a community health worker in Siavonga District, sees on average 100 cases of malaria a year among the 190 households she serves.

Florist Simoonga, CHW, Zambia Southern Province

Florist Simoonga travels over nine miles to and from the communities she serves as a community health worker. Photo: PATH/Chelsea Montes de Oca.

Florist has been a community health worker for three decades. Residents of her community and the local health post fondly refer to her as Nurse Florist, perhaps because she’s become a resource for quality care across health conditions.

“When I first started I learned to distribute malaria drugs but after that I learned how to look after people with TB and HIV,” Florist explained. “From there I learned how to deliver babies and became part of the Safe Mother Action Group in 2014. I’ve helped deliver 15 babies in my community.”

Florist travels over nine miles to and from the health facility. She not only serves her community but has become a respected, honorary member of the health facility staff. “They tell me to go talk to community members about a health issue and within one hour the clinic will be full,” Florist remarked with pride.

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Florist Simoonga holds up her chitenge, a traditional wrap worn by Zambian women, that has public health messages like “Mosquitoes kill; kill mosquitoes” and “Vaccinate children against measles." Photo: PATH/Cassi Flint.

Health workers are trained to sensitize communities on how to prevent and treat malaria. It’s critical that this information reach these communities but just as critical is who delivers that information. An appeal to take malaria preventative medication while you’re pregnant becomes easier to swallow if that request comes from a trusted member of the community.

When asked what she was most proud of as a community health worker Florist noted, “I have a voice. I am proud of that and my family is proud of that.”

Malaria: a rural disease

Zambia is roughly the size of France, but with less than a third of France's population, and malaria tends to thrive in rural settings. Zambia’s national objective is to ensure that 100 percent of those suspected to have malaria get tested and all who test positive receive treatment within 24 hours. To do this, they will need thousands of dedicated champions to carry out this mission in the most remote parts of the country. Who better to fight for communities than members of communities?

Fighting the oldest and deadliest disease known to man takes innovative strategies and technology. We need rapid diagnostic tests, we need visualization tools to help us better track outbreaks, and we need persistent people to chase down every last parasite. Malaria is a worthy opponent, with the ability to hide from us and sometimes evolve past our medical advancements. In spite of that, malaria has reached record lows in parts of Zambia due to the efforts of an even worthier opponent: community health workers.

The persistence and tenacity of these volunteers is saving lives and accelerating Zambia toward a malaria-free future.

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