In Zambia, threats of COVID-19 have coincided with peak malaria season – a time when vulnerable communities are most at risk for malaria outbreaks. This situation presents unique challenges for malaria program coordinators and field staff who are part of the Anglican Diocese of Lusaka Cross Border Malaria Initiative.
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Monica Mvula, a program coordinator based in Mongu district, has facilitated the distribution of soap and PPE for malaria volunteers in Simulumbe, together with health facility staff. These items will help protect the volunteers from COVID-19 and will reduce the risk of community spread in the case that COVID-19 reaches Mongu. At the same time, Monica is doing all she can to address a malaria outbreak and stock outs of rapid malaria tests. 

Monica shared information about a particularly concerning situation in Simulumbe in late April, where 195 malaria cases were diagnosed in just one week. After confirming these cases, the clinic ran out of rapid tests. Therefore, the actual number of cases was likely higher.

With support from the Isdell:Flowers Cross Border Malaria Initiative, Monica was able to urgently step in and provide the clinic with 225 rapid tests to ensure suspected malaria cases could be tested according to protocols.

Though malaria is spreading, it is being confronted by Monica and a team of trained malaria volunteers. As of today, Monica is continuing to follow up on untreated cases within her program areas in Mongu. 

Emmanuel Mutoya is a Community Health Worker in Liuwa Plain National Park – located in Western Province, Zambia. Liuwa park is home to tens of thousands of wild animals which live alongside a population of approximately 10,000 people, all of whom are at risk of malaria.

According to Emmanuel, much of his malaria work continues even as the COVID-19 pandemic threatens communities like his. During a conversation on May 7th, Emmanuel shared that he is still testing people with suspected malaria and treating those who are positive. In addition, Emmanuel still does active follow up of index cases; If someone tests positive for malaria, those living within 140 meters of the positive case are tested for malaria and treated if positive.  
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This photo, taken before the COVID-19 pandemic, shows Emmanuel conducting a rapid diagnostic test in the Salunda health facility catchment area.

Emmanuel shared that COVID-19 has introduced fear into his interactions with clients.

“When people come to us, especially people who we don’t know where they are coming from, they bring fear to us,” he explained. “But we test them.”
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CHWs like Emmanuel now have PPE and soap. Emmanuel wears a mask when he tests a client, and the client wears a mask as well.

Emmanuel explained that the way he provides malaria education to his community has changed drastically since the COVID-19 pandemic began. He used to bring large groups of people together to provide malaria education, but now this is done on a person-to-person basis, and fewer people are being reached.

“We still sensitize those who come to us who are sick – so we talk to them and give them education about how they can prevent malaria,” he explained. “But it is not like the way we used to do it where we can bring a lot of people together.”  
 
 
 
Funding from the J.C. Flowers Foundation’s Isdell:Flowers Cross Border Malaria Initiative (IFCBMI) supported the training of a cadre of Community Health Workers (CHWs), including Emmanuel, in 2017. These CHWs are trained by Zambia’s National Malaria Elimination Centre, and are supported and supervised by IFCBMI’s partner, the Anglican Diocese of Lusaka Cross Border Malaria Initiative.  ​

In the midst of our efforts towards malaria elimination, COVID-19 has grasped our attention as a new, dangerous, and still poorly understood threat.
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We collectively seek to end COVID for the same reasons we seek to end malaria. We fight both COVID-19 and malaria because they limit development at the family, community, and national levels. We fight both COVID-19 and malaria because they squelch economic opportunities for families and nations. Ultimately, we fight both COVID-19 and malaria because they steal our precious and rich lives, and even one life lost prematurely is one life too many.
 
Though COVID-19 is still poorly understood, we know how to prevent, diagnose, and cure malaria. The loss of 430,000 people each year to malaria is not inevitable. Now, more than ever, we must not let ourselves become distracted from the efforts that we know contribute to malaria’s elimination.
 
Worryingly, a modelling analysis from the World Health Organization shows that a de-prioritization of malaria interventions could lead to a doubling of malaria deaths. Under the worst-case scenario, in which all insecticide-treated net campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach 769,000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen in the year 2000.
 
Now is a time for malaria partners to unite to fight. We’re joining the Global Fund to Fight AIDS, Tuberculosis and Malaria in calling attention to the critical need to maintain the gains the world has made towards malaria elimination.
 
Led by The Global Fund, The Unite To Fight campaign highlights the critical role health workers in saving lives. 

As part of this campaign, we will be sharing insights and brief stories from communities where the Isdell:Flowers Cross Border Malaria Initiative is working in partnership with national malaria control and elimination programs to defeat malaria.

In the coming weeks, we will share the efforts of malaria activists and health workers like Emmanuel Mutoya from Western Province, Zambia, who continue to fight each and every day for malaria elimination. 

Faith leaders and J.C. Flowers Foundation partners are advocating for malaria elimination this World Malaria Day. Read statements from The Right Revered David Njovu, Sheikh Dr. Shaban Phiri, and The Right Reverend Andre Soares below. 

Statement from Rt. Rev. David Njovu and Sheikh Dr. Shaban Phiri
This statement originally appeared on Zambia's End Malaria Council webpage.

"Today, in celebration of World Malaria Day, we call on all Zambians to join us in praying for the sick, caring for the afflicted, and protecting those whom are vulnerable to malaria.

Malaria affects more than 5 million Zambians each year. It weakens our families and kills pregnant women and our children. Defeating it must be a priority and a spiritual necessity.

Our faith teaches us that even the smallest things can be powerful and are worthy of our attention. In the Quran, Allah is “not ashamed to set forth any parable, even that of a mosquito” (Holy Quran 2:25). Although mosquitoes may be very small, they are the deadliest creatures on Earth because of the even smaller diseases they transmit. When we ignore the mosquito and malaria, we weaken our faith and our health.

Faith also demands that we care for ourselves (“Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God?” 1 Corinthians 6:19-20); our families (“Anyone who does not provide for their relatives, and especially for their own household, has denied the faith and is worse than an unbeliever.” 1 Timothy 5:8); and our communities (“Carry each other’s burdens, and in this way you will fulfil the law of Christ.” Galatians 6:2). Luckily, fulfilling our spiritual duty is easy: (1) sleep under a mosquito net every night, (2) go to a community health worker or clinic if you or your family member has a fever, and (3) make sure that your neighbours are aware of the risks of malaria and take precautions too.

If you do not do these things, then remember the proverb: “A prudent person foresees danger and takes precautions. The simpleton goes blindly on and suffers the consequences.” (Proverbs 27:12).

We also call on faith leaders across the country to ensure that all Zambians are protected against malaria. We have a weekly platform to promote prudent behaviours amongst our flock. We also participate in pivotal moments, such as baptisms, when we can educate parents about the importance of sleeping under a mosquito net. If they do not have a net, there will be a nationwide campaign to distribute them this year.

Along with our fellow members of the End Malaria Council and all Zambians, we declare that 'malaria ends with me.'"

Statement from Rt. Rev. Andre Soares

"On this World Malaria Day 2020, we remember the memory of our beloved and fellow countrymen, lost by malaria disease, a preventable and curable disease.

With good reason, and with the hope of avoiding unnecessary deaths while this possibility still exists, the world is paying attention to COVID-19's raging and violent illness.

And in the midst of this COVID-19 pandemic, we must pay equal attention to a disease that kills even more people annually: malaria.

Everyone is taking action to prevent COVID-19, and if we had a treatment, everyone would rush to get it. But we already have ways of preventing malaria, and we already have a cure for malaria, but we do not facilitate and enjoy sufficient access to these precious resources.

Each of us has to take our responsibility to avoid this malaria disease that is devastating us. For us in positions of responsibility that decide how to invest our resources, we must prioritize the response to this vicious disease. For those of us who have mosquito nets, we must sleep under it daily, even in the heat. For those of us who have a voice of influence, we must encourage those we lead to take appropriate action. For those of us who manage health systems, we must establish efficient input distribution systems. The motto for World Malaria Day is “Zero Malaria Starts With Me” - and truly, each of us has a role.

We serve a God who desires life in abundance for his people. As Moses urged the people of Israel: CHOOSE LIFE, NOT DEATH!

For a malaria-free generation!"

-Dom André Soares, Bishop of the Diocese of Angola, Anglican Church

It was the first week in March when Shepherd Mahlahleni, a field officer for the Diocese of Matabeleland’s Anglican Cross Border Malaria Initiative (ACBMI) in Zimbabwe first heard news of a possible malaria outbreak in the Negande area of Kariba District. Mahlahleni received phone calls from three village health workers (VHWs) – Tiller Mpofu, Simuguka Siamwiriyo and Sekai Zandu – alerting him of the malaria cases.

VHWs like Mpofu, Siamwiriyo, and Zandu are trained by Zimbabwe’s Ministry of Health and Child Welfare to carryout essential malaria education, rapid testing, and treatment for those who test positive for malaria. Because they are selected by and live in the communities they serve, they are often the first to detect emerging malaria outbreaks.

While it is not uncommon for areas like Negande to experience an increase in the number of malaria cases during March and April (the rainy season), the number of new cases in Negande was a cause for concern for Mahlahleni and the Kariba District Health Office.

As the district began dealing with the urgent needs arising from the COVID-19 pandemic, it became difficult to maintain the normal level of prioritization for malaria activities, Shepherd noted. Routine malaria education and sensitization were not occurring with the same level of intensity as past years, and health staff that typically focus on malaria-related activities were conducting other activities such as food aid distribution.

As fears of COVID-19 spread among rural communities, so did malaria.

In response, Mahlahleni and Muchenje Oswell, the District Environmental Health Officer in Kariba District, visited Negande in March to investigate the malaria cases. They discovered mosquito breeding sites in stagnant bodies of water, which are also a source of water for the nearby communities for household use. They also discovered a shortage of rapid malaria tests in the Negande health clinic because so many more people than normal had presented with fevers.

Those most affected by the malaria outbreak were adults who engage in farming activities along the river soon after the rains, Mahlahleni and Oswell reported. These farmers leave their permanent houses to stay in temporary structures in order to guard their crops from wild animals, therefore exposing themselves to mosquito bites.

Following the trip to Negande, Mahlahleni prioritized the redistribution of rapid tests from a local pharmacy near his office to Negande so that all of Negande’s VHWs and the health centre were fully equipped to test all those who needed a malaria test. VHWs intensified their community education, including encouraging increased prevention measures, such as wearing long sleeves.

Like many countries across Southern Africa, Zimbabwe is under lockdown orders with the goal of preventing the spread of COVID-19. Under the supervision of Zimbabwe’s National Malaria Control Programme and ACBMI, which works in partnership with the J.C. Flowers Foundation’s Isdell:Flowers Cross Border Malaria Initiative (IFCBMI), VHWs in Negande have continued to conduct malaria education within the community while observing COVID-19 social distancing guidelines. They are sharing messages on malaria prevention and encouraging those with fevers to go to a VHW or their local clinic for testing. The number of malaria cases has decreased.

Despite these efforts, Mahlahleni worries that the progress made by ACBMI, in partnership with IFCBMI and Zimbabwe’s National Malaria Control Programme in reducing cases in Kariba district, could be reversed.

​Unfortunately, Negande is one of many communities in Zimbabwe that is experiencing additional challenges during what is already peak malaria season.

As the world struggles to respond to COVID-19, there is a significant risk that prevention and treatment programs for malaria will be disrupted, despite guidance from the World Health Organization that states malaria activities should continue.

As we celebrate World Malaria Day on April 25th, it is important to acknowledge that current investments in malaria are saving almost 600,000 lives and preventing nearly 100 million cases a year. Efforts to limit the spread of COVID-19 are necessary to protect health systems, enabling them to continue to serve the population throughout the crisis. At the same time, these efforts must continue to preserve access to life-saving malaria prevention, diagnosis and treatment services or threaten to reverse decades of hard-fought progress against malaria.

This article was originally published on All Africa. 

LIVINGSTONE, ZAMBIA — February 28 2020 –  The global community has its sights set on malaria eradication. The Lancet Commission on Malaria Eradication’s report, Malaria eradication within a generation: ambitious, achievable, and necessary , released in September 2019, laid out necessary steps to eradicate malaria – a preventable disease that continues to affect the most vulnerable communities throughout Africa – by 2050. The World Health Organization’s Strategic Advisory Group on Malaria Eradication (SAGme), which released an executive summary of its findings in August 2019, will soon publish a full report that analyzes future scenarios for malaria and reaffirms that eradication is a goal worth pursuing, likely to save millions of lives and billions of dollars. Experts involved in both bodies of research recognized the importance of community-driven responses to malaria eradication, as well as the development of new tools and technologies, increased funding, and national-level leadership for malaria eradication.

Read the full article here. 

​This story was originally published by allAfrica.

Luanda, Angola — The Angolan Council of Christian Churches (CICA) and the Anglican Diocese of Angola convene leaders from government and civil society to announce their leadership in advocacy for malaria elimination.

Anglican Bishop André Soares announced the formal launch of an Interfaith Commission for the Fight against Malaria on December 2nd during a high-level panel featuring faith, government, and non-governmental leaders. He invited representatives from all faith communities to participate in this commission, spearheaded by the Anglican Church, CICA, and Caritas.

"We have come here today, on the 2nd of December, for the church to make a commitment, starting right now, to unite in the fight against malaria," said Bishop Andre Soares. We will consolidate our efforts, with all religious leaders united together."
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The newly launched commission will advocate for the elimination of malaria – a preventable disease that continues to threaten the health and well-being of Angola, as noted in the 2019 World Malaria Report released last week;11,814 malaria deaths and over 5 million malaria cases were reported in the country in 2018.

​Read the full article here. 

As we reflect on 2019, one event worth remembering was the Isdell:Flowers Cross Border Malaria Initiative Round Table, held February 28 – March 1, 2019 in Livingstone, Zambia. Promoting the 2019 World Malaria Day slogan of “Zero Malaria Starts With Me,” the Round Table focused on community engagement in the context of malaria elimination. Government officials, representatives from malaria-endemic communities, and program, academic, and private sector partners convened at the Round Table to discuss the necessity of community engagement and the involvement of those directly affected by malaria in malaria elimination efforts. Participants shared practical examples and principles of successful community engagement activities. Three core principles of effective community engagement emerged: 1) there is no “one size fits all” community engagement strategy; 2) community engagement must be a bidirectional activity; and 3) community members must be at the heart of malaria elimination efforts. Detailed Round Table proceedings were written up and published as a meeting report in Malaria Journal, which can be found at here.

The J.C. Flowers Foundation’s Isdell:Flowers Cross Border Malaria Initiative is launching FLAME (Faith Leader Advocacy for Malaria Elimination). FLAME will catalyze and strengthen interfaith coalitions of religious leaders for malaria advocacy. These coalitions – based in Angola, Zambia, Namibia, and Zimbabwe – will seek to amplify the advocacy voice of religious leaders for malaria elimination in a manner that is aligned with national malaria control and elimination program priorities. The coalitions will address the challenge of imperfect policies and insufficient funding to eliminate malaria.

Religious leaders can be effective advocates by serving as a bridge between technical experts and decision-makers. Recognizing the unique role of religious leaders in malaria elimination, IFCBMI has partnered with the Anglican Church in Southern Africa for more than 10 years. FLAME will build upon IFCBMI’s existing work with faith leaders and will include leaders from diverse faiths and traditions throughout the four countries.

Once recruited, faith leaders will receive training in malaria and advocacy, and will form interfaith coalitions to advance technically informed advocacy for policies and funding to accelerate malaria. 

On July 30 to August 1, 2019 the South African Medical Research Council (SAMRC) Office of Malaria Research hosted the 5th Annual Malaria Research Conference at the University of Pretoria’s Future Africa Campus. The theme of this year’s conference, “Cooperation for Elimination,” is at the heart of the malaria elimination activities carried out by The Isdell:Flowers Cross Border Malaria Initiative of the J.C. Flowers Foundation (IFCBMI). Presenter and attendee disciplines varied widely, including parasitology, epidemiology, global health economics, political and organizational leadership, and community mobilization/activism, among others. IFCBMI represented the work of its team members and program communities with two oral presentations, four poster presentations, and panel discussion contributions. Alexandra Gordon, Program Officer for IFCBMI, won the award of “Best Poster of the 5th Annual Malaria Research Conference, for her poster titled: “Data for Action: How standardized, community-based data collection and action planning can inform program prioritization and advocacy efforts.”

Constance Njovu, IFCBMI Regional Coordinator, presented on Social and Behavioral Change Communication (SBCC) in the context of malaria elimination. “There is no successful malaria elimination intervention without community-driven Social and Behavioral Change Communication,” Njovu explained. To illustrate this, Njovu presented an example of a successful community-driven SBCC initiative in Zambia where community health workers consulted traditional leaders to develop and deliver messaging to address the lack of acceptance of community-based malaria testing. Messaging centered on dispelling myths and promoting community health, and was delivered in ways that the community preferred (e.g. community meetings and church services). Because the community trusted the traditional leaders’ messages and authority, the community grew to accept community-based blood testing for malaria.

The IFCBMI Team also gave four poster presentations. João Baptista Nelo, IFCBMI Provincial Coordinator in Angola’s Cuando Cubango Province, presented on the community engagement methodology being employed in Cuando Cubango Province. In partnership with the Council of Christian Churches in Angola, IFCBMI mobilized a network of Community Malaria Elimination Committees in four municipalities. These committees take on a leadership role for the ongoing effort to promote successful malaria interventions, identify barriers to success, and identify and implement appropriate solutions. Ndakudana Hamukwaya, Northern Program Officer of the Namibia Anglican Community Development Organization, presented on how community-driven SBCC approaches that were tailored to the specific barriers to malaria elimination in the Ohangwena and Omusati regions of Namibia strengthened community engagement and action. João Lino Rafael, Angola Operations Manager, presented on a collaboration between communities and stakeholders in Calai, Angola and Rundu, Namibia to address the issue of cross border treatment seeking at Rundu State Hospital. The award-winning poster of Alexandra Gordon, Program Officer, described a monitoring and action plan developed by IFCBMI to facilitate community-informed programmatic decision-making. As part of this process, program monitoring data collected in February and March 2019 were shared with stakeholders at the community and regional levels through guided discussions that facilitated deeper community-based analysis, resulting in detailed action plans.
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To wrap up the conference, Rebecca Vander Meulen, Executive Director of the J.C. Flowers Foundation, participated in a panel discussion entitled “Translating Research into Policy.” Alongside Dr. John Chimumbwa, newly appointed Executive Director of the SADC Malaria Elimination 8 Secretariat, and four other panelists, Vander Meulen discussed how to translate important research and sound policy into the practical reality of malaria on the ground. Vander Meulen emphasized the importance of recognizing all of the experts who must work together for malaria elimination—both the scientists and the community members living in malaria-endemic communities. Just as a parasitologist is an expert in Plasmodium falciparum, a mother is an expert in the dynamics of her own community and the care of her children. The only way we will attain malaria elimination is if we practice “Cooperation for Elimination” and value the expertise of the mother who chooses to put her child to sleep under a net as complementary to the expertise of scientists and public health professionals. ​