In Zambia, through the MAMaZ Against Malaria (MAM) and MAMaZ Against Malaria at Scale (MAM@Scale) projects, Transaid delivered its largest scale-up ETS intervention to date which has reached nearly one million community members since its inception in 2017. Trained Community Health Volunteers (CHV) were instrumental in the running of a community-based ETS consisting of 70 bicycle ambulances. In an effort to prevent mortality in children under six due to severe malaria, the project sought to tackle the practical barriers and delays in accessing healthcare services at the primary healthcare level.
The MAM@Scale project shows the value of investing in rural mobility. When interventions are implemented in a manner that generates community ownership and are responsive to community needs, the benefits are far-reaching and sustainable. This approach changes the way communities are able to access vital health services and for health care to become people-centred as envisioned in the Sustainable Development Goals. At the very least, it is an incremental step in the right direction towards achieving universal access.
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The MAM@Scale project sought to support the scale-up of an evidence-based intervention that aimed at increasing access of hard-to-reach communities to effective treatment for severe malaria in high malaria burden settings. The project was implemented in phases, i.e., Transition to Scale 2 (TTS2) which was implemented in two demonstration districts and three National Scale Up (NSU) districts and TTS3 which was implemented in the five TTS2 districts and another additional five NSU districts. The endline was carried out in selected project areas during the months of October and November 2021 to determine the contribution of the project towards increasing the access of hard-to-reach communities to effective treatment for severe malaria in high malaria burden settings. Findings were compared to those of the baseline survey (February 2019) and the midline survey (July 2020).
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The term gender-based violence (GBV) includes any form of violence against women. Despite a favourable policy environment with the introduction of the anti-GBV law, GBV statistics in Zambia remain high. Of women aged 15-49 years, 43% have experienced physical violence at some point in their lives, 37% in the previous 12 months. Moreover, 17% of women and girls have experienced sexual violence, and 10% have experienced violence while pregnant (2014 Zambia Demographic and Health Survey).
Continuing the work of a predecessor programme, MAMaZ (2010-2013), which was funded by UK aid from the UK government, the Comic Relief-funded MORE MAMaZ programme (2014-2016) took steps to integrate a focus on GBV into the training of Safe Motherhood Action Group (SMAG) volunteers.
The MORE MAMaZ GBV interventions resulted in transformative change for women. Intervention communities reported a very significant reduction in GBV. Some communities perceived that GBV had been eliminated, with these changes attributed to the work of the SMAG volunteers.
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According to Zambia’s national Health Management Information
System (HMIS), a reported 1,851 Zambians died of malaria in
2016. Many other malaria deaths occur at community level and
go unrecorded. Reported malaria cases increased between 2015-
2016. If Zambia is to achieve the global target of a 40% reduction
in malaria incidence by 2020, a priority focus on areas of highest
mortality, including severe malaria in young children, will be
important.
This evidence brief presents the key results from the MAMaZ Against Malaria (MAM) project, a pilot focused on increasing rural communities’ access to rectal artesunate.
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In this webinar, held on 01.02.2022, the project team and partners presented the final results from MAMaZ Against Malaria at Scale, a project that supported the roll-out of quality assured pre-referral RAS in Zambia.
The webinar traced how the project scaled up from a small single-district pilot in 2017 to a much larger-scale initiative that was implemented in ten districts by 2021. Experience and lessons learned along the way were shared by the team. This webinar was also an opportunity to hear the plans for further national scale-up within Zambia.
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As the global development agenda converges around the Sustainable Development Goals (SDGs) and aims for Universal Health Coverage (UHC), there is much emphasis on the need for an inclusive development approach. To achieve this, communities need to be at the centre of interventions and must have the knowledge and resources to drive their own development agenda according to their local needs. However, in rural Zambia, as in many other sub-Saharan African contexts, communities continue to face multiple barriers in accessing basic services. Underlying factors include geographical, financial and social constraints.
The MAMaZ Against Malaria (MAM) and MAM@Scale projects aimed to reduce preventable deaths from severe malaria by introducing and expanding the availability of an innovative pre-referral intervention at community level in remote rural districts in Zambia over the period 2017-2021. In this evidence brief, we share the final results of the MAM@Scale project.
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The MAM@Scale project is a scale up of the pilot project which was carried out in Serenje district between July 2017 and July 2018. The main objective of conducting the midline review was to gauge progress to date of the MAM@Scale activities. The results in this report reflect progress part way through implementation of the project (the current phase of the project ends on 30 November 2020). The review was carried out in selected project areas to review progress in achievements and assess the possible change that can be attributed to the project, particularly with regards to management of cases of severe malaria. The review was conducted in June and July 2020.
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As the global development agenda converges around the Sustainable Development Goals (SDGs) and aims for Universal Health Coverage (UHC), there is much emphasis on the need for an inclusive development approach. To achieve this, communities need to be at the centre of interventions and must have the knowledge and resources to drive their own development agenda according to their local needs. However, in rural Zambia, as in many other sub-Saharan African contexts, communities continue to face multiple barriers in accessing basic services. Underlying factors include geographical, financial and social constraints.
Click below to read the full brief.
Gender equality and women’s empowerment are key to achieving universal health coverage. They are also important in their own right as a means to achieve sustainable development. Building on a successful gender mainstreaming approach used in three earlier projects, MAM@Scale integrated a focus on gender into the design of a severe malaria intervention in Zambia. Community health volunteers (CHVs) were trained to administer quality assured 100 mg rectal artesunate to children with severe malaria danger signs at community level and to refer patients to the health facility for further treatment. The project’s gender strategy aimed to address the wide range of social norms and gender stereotypes that prevented rural households from responding promptly to severe malaria and other child health emergencies.
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In early March 2020, coronavirus (COVID-19) was declared a pandemic by the World Health Organization. Many countries had started to take steps to isolate suspected cases, ban mass gatherings and public events, close schools and universities and impose social distancing. At the time, MAMaZ Against Malaria at Scale (MAM@Scale) was implementing a community level intervention to address severe malaria targeted to young children in five districts of Zambia, working in partnership with district health teams. Responding to an urgent request by the Ministry of Health (MOH) for development partners to help build community preparedness and resilience, the project swiftly pivoted its activities to integrate a COVID-19 focus.
This evidence brief looks at how MAM@Scale adapted a severe malaria intervention in Zambia in the context of COVID-19.
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Over 7,500 malaria deaths occurred in Zambia in 2018 and children under six are the most susceptible due to their lack of immunity. MAM@Scale empowered Zambian families in five districts (Chitambo, Serenje, Chama, Manyinga and Vubwi) to reduce their mortality risk from severe malaria by introducing artesunate rectal capsules (known locally as rectal artesunate or ‘RAS’), a cutting-edge pre-referral intervention given at community level to children aged six months to six years old. The MAMaZ Against Malaria (MAM) pilot project (2017-2018) reported a reduction in severe malaria case fatality from 8% to 0.25% in intervention sites in Serenje district.
Building on this evidence base, MAM@Scale began implementation in December 2018 with funding from Grand Challenges Canada, Medicines for Malaria Venture and Transaid. Originally an 18-month intervention, additional funding from FIA Foundation, Grand Challenges Canada and a private donor extended the project by six months and enabled the inclusion of a COVID-19 focus. MAM and MAM@Scale built on a longer-term investment in community health systems strengthening by two earlier projects.
This evidence brief looks at scaling up progress so far and highlights some key lessons to guide wider national scale up of the innovation.
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