When the Malaria Booster Project (MBP) was launched in April 2006, combating malaria was a large challenge in Zambia, one of the poorest countries in Africa. Malaria was the country’s leading cause of morbidity and the second highest cause of mortality, and was endemic in all of Zambia’s nine provinces. The mosquito-borne infectious disease contributed to an estimated 40 percent of under-five deaths and 20 percent of maternal deaths. There were 4.3 million cases per year, and an estimated 50,000 malaria-related deaths annually. Over a third of outpatient hospital visits were also caused by malaria. The incidence rates of malaria had tripled in the preceding three decades, from 121 cases per 1,000 in 1976 to 376 cases per 1,000 in 2004. The disease also had a negative impact on Zambia’s economy, reducing Zambia’s gross domestic product (GDP) by an estimated 1.5 percent every year.
The target population of the project is Zambians living in all 72 malarial districts of the country, with a special focus on children under age five and pregnant women. The project aided government efforts to accelerate and intensify malaria interventions. It supports the rapid expansion in coverage and utilization of effective prevention and treatment interventions such as intermittent presumptive treatment (IPT) for malaria for pregnant women, indoor residual spraying (IRS) of structures and the use of treated bed nets. Furthermore, the project includes a health system strengthening component, which helped build up the public supply-chain for essential drugs. This in turn greatly improved access to life-saving malaria drugs in rural areas.
Between 2006 and 2008 when IDA was one of the main financiers to the National Malaria Control Program (NMCP), it achieved the following outcomes:
- The percentage of households owning at least one insecticide-treated net (ITN) increased from 38 percent to 62 percent.
- Percentage of pregnant women who received a complete course of IPT for malaria augmented from 59 percent to 66 percent.
- The population covered by IRS increased from 1.3 million during the 2005/6 transmission period to 3.5 million during the 2008/09 transmission period.
- A 68 percent reduction in child anemia and a 53 percent drop in child malaria parasitemia.
The annual number of malaria death in the country decreased by at least 50 percent during the period 2000-2008, during which the population rose by 30 percent, implying a reduction in the death rate of over 60 percent. Just during the years 2006-2008, under-five malaria deaths decreased from 3,235 to 2,680 (17 percent), thus a large number of children were saved from malaria. These outcomes contributed to the reductions in under-five (29 percent) and infant mortality (26 percent) observed between 2002 and 2007, as well as achievements towards the health-related Millennium Development Goals (MDGs).
IDA funds were also used to support improvements to the public supply chain for pharmaceuticals. The following results were observed through a rigorous impact evaluation:
- Availability of drugs increased: for example for Pediatric ACT (malaria drug for children) stock-out rates reduced from 43 percent to 12 percent.
- The revised estimated impact on health outcomes from the improvement in availability of ACT’s to treat malaria in children is a 21 percent reduction in under-five child deaths due to malaria (on a national level an estimated 16,600 children can be saved before 2015).
The MBP was originally financed through an IDA credit of US$20 million.
There is a strong group of development partners that are supporting the National Malaria Control Program (NMCP) to implement the National Malaria Strategic Plan. The Global Fund to Fight AIDS, Tuberculosis, and Malaria, the President’s Malaria Initiative/U.S. Agency for International Development (USAID), and IDA were the three key donors during the implementation of the MBP. These partners worked together and coordinated investments and analytical work. IDA contributed to leveraging additional funds to the program from the Russian Federation (US$6.85 million) and the United Kingdom (US$3 million). The U.S. government, the U.K. Department for International Development (DFID), Crown Agents, the USAID | DELIVER PROJECT and John Snow, Inc. were partners in the supply-chain work.
Overall, financial sustainability of the malaria program remains a challenge. As a result, the government requested additional IDA financing of US$30 million in 2010 to scale up coverage of cost-effective interventions while maintaining success in the program. The additional financing is currently under preparation. The government has also indicated its intention to scale-up the pilot program on supply-chain management of pharmaceuticals nationwide.
The project has received much positive feedback from beneficiaries, such as the following:
“In the past, we used to get a lot of prescriptions without access to actual medication,” said Mwansa Kasonde from Mungwi, 30 km from Kasama, in the Northern Province [see photo of beneficiary in Multimedia section]. “They would tell us to go and buy from drug stores whose price was exorbitant. These days, we get free medication from our nearest health facility.”
Oscar Bwalya, who works at the Rural Health Center explains that “Drug availability has improved tremendously, particularly anti-malaria and antibiotics. We now have the ability to order according to demand and this has ensured access to a variety of medicines by our community.”
“I look forward to this [the supply chain improvements] being scaled up across the country because we are telling a very successful story,” said Grace Nanyinza, from the public health center at Mungwi.