Insecticide Treated
Nets (ITNs) Program
Churches Medical Association
of Zambia (CMAZ)
Church or denomination: N/A
Project summary: The Churches
Medical Association of Zambia (CMAZ) is an active implementing partner the
national Roll Back Malaria (RBM) campaign. Roll Back Malaria addresses
malaria through the development of partnerships, prevention, case management,
prophylaxis, improved human resources and capacity building, epidemic preparedness,
monitoring and evaluation, and research.
Background/ History: CMAZ
was formed in 1970 through the merging of the Medical Committee of the Christian
Council of Zambia and the health department of the Zambia Episcopal Conference,
following a recommendation by the World Council of Churches (WCC). CMAZ
represents the interests of church administered health institutions in Zambia,
where member churches work in the entire country and are responsible for
providing 30% of all health care and 50% of rural health care. Specifically,
CMAZ’s role is to provide representation and advocacy, administrative and
logistical support, technical support, and resource mobilization assistance
for member churches.
Malaria, the most significant
health problem in Zambia, is endemic in all 9 provinces of the country. Incidence
rates have tripled over the past 23 years and chloroquine resistance is now
up to 52% in some areas. It accounts for the loss of 6.8 million disability-adjusted
life years (DALYs).
As part of the malaria work CMAZ
coordinates the research activities of Macha Hospital’s Malaria Research
Institute. This research facility collaborates with national and international
universities and research centers to conduct clinical trials and community-based
malaria research. The institute has published much of their research in
international academic journals.
Goals:
The overarching goal of the CMAZ malaria program
is to reduce the incidence of malaria in CMAZ program areas.
Objectives:
§ Develop effective malaria control Information, Education, and Communication
(IEC) strategies in all member institutions
§ Integrate malaria control
with Primary Health Care (PHC) and Home-based Care (HBC)
§ Develop skills needed for
marketing, distribution and impregnation of insecticide-treated nets
§ Prevent hospital transmission
of malaria by use of insecticide-treated nets in all hospital wards
§ Institute national malaria
surveillance
§ Monitor and evaluate insecticide-treated
net program implementation
Who does the work? Much of
the work of CMAZ is implemented by the umbrella organization as well as member
health facilities and organizations. The community-based aspects of the project
are managed by 5 supervisors, who are each responsible for the work of 26
animators that coordinate the work of 8 groups of 10 volunteers. Each of
these volunteers is then responsible for a specific set of households.
Main activities: The main
activity of CMAZ is providing 30-50% of malaria control efforts for Zambia.
The organization does this through:
Prevention activities:
§ Promoting the use of
insecticide-treated nets
§ Controlling mosquito populations
§ Information, Education,
and Communication programs for behavior change
Monitoring and evaluation:
§ Disease surveillance
§ Establishing indicators
and monitoring and evaluation of activities
Partnerships:
§ Government
§ NGOs
§ Research Organizations (National
Malaria Control Center)
Case management and prophylaxis:
§ In-patient management
§ Chloroquine prophylaxis
for children under 5 and pregnant women
Research:
§ Hospital-based operations
research
§ Community-based research
§ Macha hospital- model research
facility
Expected outcomes: See
objectives listed above.
Results:
To date the program has distributed Information,
Education, and Communication materials on malaria management in children
and Roll Back Malaria. The program has also undertaken a series of insecticide-treated
net workshops and produced an insecticide-treated net calendar. All maternity
and pediatric wards have insecticide-treated nets. There is also now an
increase in community demands due to an exemplary “Net Culture.” Insecticide-treated
nets are fully integrated in PHC and HBC. 10 out of 16 hospitals (62%) have
received the training in insecticide-treated net management.
The program has well-defined
indicators including:
§ Reduced costs of nets and
insecticide
§ Increased hospital beds
covered with insecticide-treated nets
§ Increased households owning
nets
§ Increased households redipping
nets
§ Increased women and children
under 5 sleeping under nets
§ Increased number of health
care workers trained in insecticide-treated net promotion and implementation
§ Increased type and quantity
of education materials
Lessons learned:
An effective insecticide-treated net program requires
extensive community sensitization. High insecticide-treated net sales do
not necessarily mean a reduction in malaria incidence and mortality. Net
retreatment must also be promoted together with net use. An effective insecticide-treated
net program requires an effective monitoring system and communications with
key players. It also requires behavior change strategies to develop a “Positive
Net Culture”. For sustainability, full cost recovery is a must. The dilemma
arises between the desire to increase access versus the need to fully cost-recover
among poor communities. Duty and VAT exemption are necessary for sustainability
as import costs remain relatively high.
The major constraints in the
program are inadequate supply of mosquito nets (due to limited funding),
coverage, and transport for distribution and monitoring.
Funding and other resources:
N/A
Further readings or documents:
N/A
Contact information:
Churches Medical Association
of Zambia
P.O Box 34511
Lusaka Zambia
Telephone: +260-1- 237328
Fax: +260 - 1- 223297
E mail:
biemba@zamnet.zn
(Godfrey Biemba)