No continent suffers the ravages of malaria more than Africa. And in Africa, no country bears more of malaria’s burden than Zambia. Overall, the disease threatens Zambia’s population, healthcare system, and economy. Endemic in all 9 provinces, malaria has been the country’s leading cause of morbidity and the second-highest cause of mortality, with an estimated 4.3 million cases and 50,000 deaths a year. Its impact looms over the health sector — responsible for 45 percent of hospitalizations, 40 percent of under-5 mortality, and 20 percent of maternal mortality. Because of worker absenteeism and enormous productivity losses, malaria exacts an estimated 1.5 percent from the national income every year.
In 2006, Zambia’s Government launched the 2006–2011 National Malaria Strategic Plan. The Plan’s ambitious targets included reducing the incidence of malaria by 75 percent and child mortality by 20 percent; securing treatment for at least 80 percent of new malaria cases within 24 hours of symptom onset; and providing treated bed nets or indoor spraying for at least 80 percent of those at risk of malaria, particularly pregnant women and children under 5 years of age.
To bolster the Government’s agenda, the IDA-financed Zambia Malaria Booster Project was launched in 2006. It worked to strengthen the national health system to improve service delivery, increase community demand-driven interventions, and build institutional capacity in the Ministry of Health. Overall, the project aimed to improve malaria prevention and treatment, especially for children under age 5 and pregnant women. Specifically, the project aimed by 2008 to increase (from 23 to 40 percent) the number of children under age 5 who get protection from a treated bed net; increase (from 62 to 70 percent) the number of pregnant women receiving a complete course of intermittent presumptive treatment for malaria; and increase (from 27 to 60 percent) the number of people sleeping in indoor residual-sprayed structures.
Malaria deaths in Zambia have plunged by 66 percent. Zambia has reached the 2010 Roll Back Malaria target of more than 50 percent reduction in malaria mortality compared to 2000.
Highlights:
- Large population reached. Population coverage increased from 1.2 million to 3.5 million people.
- Prevention increased. The decline of malaria contraction in Zambia was rapidly aided by the distribution of 3.6 million long-lasting insecticidal nets between 2006 and 2008. The percentage of households with one long-lasting insecticide-treated bed net increased from 48 to 72 percent. Indoor residual spraying coverage increased from 15 districts in 2006 to 36 districts in 2008.
- Impact felt countrywide. During this period, malaria deaths declined 47 percent, and nationwide surveys showed parasite prevalence declined 53 percent (from 21.8 to 10.2 percent). Moreover, the percentage of children with severe anemia declined 68 percent (from 13.3 to 4.3 percent). Most moderate and severe anemia in children is caused by malaria.
- Children under five aided. Malaria cases and related deaths in children under age 5 declined 29 and 33 percent, respectively.
Zambia is one of 18 countries receiving support through the World Bank’s Malaria Booster Program. More than US$460 million have been committed for Phase I of the Government’s Booster Program (2005-2008) — a nine-fold increase from what IDA committed between 2000 and 2005. Of this amount, US$20 million has been marked for the four-year Zambia Malaria Booster Project.
IDA was the first large-scale financial donor of Zambia’s malaria strategy and, at the start of this project, the largest financial contributor. Since the start, the Global Fund and the US President’s Malaria Initiative have increased their support and will be financing a substantial part of the program this year. Technically the key partners — the Malaria Control and Evaluation Partnership in Africa, the United States Agency for International Development, and the World Health Organization — have worked jointly to support the Ministry of Health to develop annual plans, provide technical support for procurement processes, and support monitoring and evaluation.
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