Zambia community case management

Zambia has invested heavily in scaling- up community case management of malaria in the context of integrated community case management (iCCM).  According to the national guidelines, in the iCCM approach the community health workers (CHWs) and community health assistants (CHAs) are provided with diagnostic tools and medicines for the management of common childhood illnesses including the treatment of uncomplicated malaria. The malaria component targets all ages.  

CHWs are unpaid volunteers, while CHAs are Ministry of Health (MOH) employees and serve as a bridge between health facilities and communities and, where available they play an important role in coordinating iCCM. The deployment of CHAs has been quite limited to date due to human resource system bottlenecks and financial constraints (fewer than 1,500 deployed and on the payroll out of a national target of 5,000 by 2020). 

The defined roles of CHWs and CHAs in the management of uncomplicated malaria include: 

  • Carrying out diagnoses according to their training and recognizing danger signs. 
  • Using RDTs in all cases of fever to confirm malaria before treatment. 
  • Administering first-line medicine. 
  • Administering RAS as pre-referral intervention when danger signs are recognized (rectal artesunate [RAS]). 
  • Instituting measures to reduce body temperature. 
  • Following up with patients, particularly children under five years of age. 
  • Providing education to the community on the need for compliance to treatment, recognition of danger signs, and prevention of malaria. 
  • Advising when to return if the condition persists. 

In the lower-level epidemiologic settings (<200 cases/1,000 population/year), the CHWs or CHAs also test and treat asymptomatic households and neighbors in a reactive case detection (RCD) approach (aka “Step D,” or “Active Response”).  

Uptake of artesunate rectal capsules (RAS) for pre-referral intervention by CHWs and low-level healthcare facilities has been limited, but the National Malaria Elimination Centre is calling for further scale-up. A pilot program in Serenje in 2017–2018 supported by the Medicine for Malaria Venture, local NGO MAMaZ, and other partners demonstrated improved severe malaria outcomes. Zambia has since accumulated additional experience with use of RAS by CHWs for initial management of severe malaria during urgent referral to health facilities.