Since 2017, our MAMaZ Against Malaria (MAM) programme has been combatting severe malaria in rural Zambia using a combination of community education and improved access to health facilities through bicycle ambulances. The approach has been proven to work, with the MAM pilot recording a staggering 96% reduction in child deaths from severe malaria in Serenje District. The programme - MAM@Scale - has now been scaled up to reach 355 rural communities across five Zambian districts.

Now, these same communities are facing a new danger in the form of COVID-19. Although there are currently low numbers of cases reported, Zambia like many African countries will face additional challenges if the virus spreads as it has in other countries.  Health systems in the country are comparatively weak, and many people lack access to basic sanitation facilities or the financial means to self-isolate. The rural communities served by MAM@Scale are often situated far from health facilities, making them particularly vulnerable to the impact of COVID-19.

Rising to the challenge of COVID-19

In the wake of the coronavirus pandemic, the MAM@Scale programme is adapting in order to tackle COVID-19. Firstly, we were asked to support the Zambian Ministry of Health by contributing to guidelines on the role of Community Health Workers in the context of COVID-19.

Community Health Volunteers (CHVs) are a key part of the MAM@Scale programme, and indeed crucial to Zambia's health system. In response to the pandemic, we are bringing small groups of CHVs together (whilst observing social distancing rules), training them on the danger signs and protocols around COVID-19, and supporting them and their communities in establishing hand washing stations and food banks. Given the success of MAM, CHVs are well placed to disseminate key health messages in their community. They are trusted and held in high regard in their communities. We will be sharing key messages with nearly 2,000 CHVs, who, along with other targeted communications, will help spread awareness to a population of over 200,000 people.

Chola is a Community Facilitator working on MAM@Scale. Originally a fisherman, for the past nine years he has worked with MAM, as well as the MAMaZ and More MAMaZ maternal health programmes. Its his job to assemble people in communities to raise awareness about important public health issues, alongside CHVs. The most rewarding aspect of the job, he says, is seeing how his work has helped save lives in his community, both from severe malaria and maternal complications.

Awareness raising has been central to our adaptation to the new threats posed by the COVID-19 pandemic. For rural communities for whom healthcare is often difficult to access, it is vital that families are informed to make decisions about their health.

To ensure that these potentially life-saving messages reach even the most remote areas, we are using a variety of channels to sensitise communities. These include posters in English and Bemba (the local language) in areas of higher literacy. We are also using a public address system for visits to rural communities to advise of the new guidelines, as well as utilising community radio to raise awareness through announcements, jingles, and even live broadcasts with phone-in discussion. In the most remote areas, CHVs are making door-to-door visits, following social distancing protocols, to ensure that the message is communicated as widely as possible.

With a new disease comes new protocols, and CHVs and bicycle ambulance riders have had to adapt to prevent the spread of COVID-19. Both groups have undergone new training in order to adhere with social distancing and safety guidelines, with cloth masks, soap, and gloves procured for volunteers. In rural areas where handwashing facilities are limited, new tippy tap systems have been set up, a solution that is as simple as it is hygienic. Bicycle ambulance riders are now washing their bicycle ambulances in between uses to minimise the risk of COVID-19 transmission, in line with the new safety protocols.

Rabbecca has been a CHV with MAM since its inception. Speaking about her role in 2018, she simply said: "I save lives. I might be working in the field or cooking food, but if theres an emergency, I leave". In Zambia, CHVs like Rabbecca are the backbone of the health system. Their commitment has already proven to be a powerful tool in combatting severe malaria, and will no doubt be just as vital in tackling COVID-19.

How you can help

Now more than ever, rural communities in Zambia need access to vital health services. In the fight against COVID- 19, every donation counts:

- £120 could buy a strong bicycle for a health worker, enabling doctors and nurses to reach more communities every day.

- £3.90 could buy a box of 50 gloves for CHVs.

- £2.70 could buy the materials to install two tippy taps, to equip a community with two hand washing facilities.

- Just £1 could buy a locally produced face mask for a CHV.

Thank you for helping communities like Rabbecca's and Chola's tackle COVID-19. Your support really will make all the difference in ensuring that no one gets left behind in the global pandemic response.