MAM initiative: increasing access to rectal artesunate in rural communities
In July 2017, MMV joined forces with an international development organization, Transaid, as well as Development Data, DAI Global Health, Disacare and the NMEC of Zambia, to implement a pilot access project that reduced malaria case fatality by a dramatic 96%.
The project, known as MAMaZ1 Against Malaria (MAM), introduced the use of rectal artesunate (RAS) at the community level, and used locally operated bicycle ambulances to improve the transport of sick children to health centres, as well as community theatre, song and dance to raise awareness of malaria danger signs. The project was conducted in the Serenje district of Zambia’s central province, and reached 54,000 people across 45 communities, served by a total of eight health facilities.
Dr Elizabeth Chizema tells us about Zambia's approach to combatting malaria and the role of the MAM project.
1. Zambia has set itself the ambitious goal to eliminate malaria by 2021. How did this goal come about and how will it be achieved?
Despite our best efforts, Zambia continues to experience spikes of malaria. Because of this, we have decided that control is no longer enough – we need to eliminate malaria for good. So, between 2017 and 2021, we are implementing a new strategic plan designed to eliminate local transmission of malaria and, critically, prevent re-introduction of the disease. One important aspect of this is ensuring prompt and effective case management of malaria to reduce the pool of individuals who can contribute to malaria transmission.
2. What is Zambia’s approach to the case management of severe malaria?
We have revised our national policy to align it with WHO recommendations, that is, replacing quinine with more effective treatments, such as injectable artesunate. And, having trained up CHVs through the MAM initiative, we can now proactively diagnose and manage cases of severe malaria – using RAS – at the community, pre-referral level, rather than waiting for cases to present at district health facilities.
3. How can the MAM project be scaled up to close the coverage gaps?
The pilot initiative focused on one district only (Serenje). In the next phase of the project, we will expand into one new implementation district in Central Province (Chitambo) and three national scale-up districts, before scaling up even further. Training is a key part of this expansion. So far, we have trained up to 7,500 CHVs, and we aim to have trained a further 7,500 by the end of 2019. Ultimately, for maximum coverage, we hope that initiatives similar to MAM will one day be present in all 114 districts of Zambia.
4. How have you benefited from working with MMV and Transaid?
By working with multiple partners, our approach to the management of severe malaria has been comprehensive and well-integrated. Supported by MMV, we were able to introduce and increase access to quality-assured RAS and, supported by Transaid, we were able to scale up and strengthen existing services, such as the bicycle ambulances. Almost 100% of the children treated for suspected severe malaria in the pilot reached a health facility in good time – all thanks to this team approach. I hope that our experience in Zambia will inspire other African countries to consider similar projects and forge new collaborations.
1. MAMaZ: Mobilizing Access to Maternal Health Services in Zambia programme: led by Health Partners International (2010–2013, funded by DFID) and MORE MAMaZ, led by Transaid (2014-2016, funded by Comic Relief).
Dr Elizabeth Chizema