Using technology to improve health systems is a large part of the Akros ethos. Since the inception of the malaria Active Infection Detection (AID) program in 2011 in the district of Lusaka, several successes have been scored in the fight against the disease. Much of this involved the development of a system to locate areas of potential local transmission of malaria in the heart of the capital. This allowed for better targeting of interventions, and the system continues to be improved.
Recently, another innovation was introduced to the district, the use of android-based tablets for data capture at clinics and during field responses. More than 30 Health workers – mainly environmental health technicians and nurses from five government clinics within Lusaka district – were selected to attend the electronic data training. The two-day training, organized by the Zambia Ministry of Health with technical assistance from Akros, also drew representation from the National Malaria Control Center and the District Community Health Management Team.
Laying on the Great North Road, North East of Kapiri Mposhi in Central province is Mkushi District. With a population of around 150,000, Mkushi is well known for its commercial farms. It has since become one of Zambia’s leading agricultural districts with a consistent bumper harvest of maize, soya beans, tobacco and wheat.
In spite of Mkushi’s addition to Zambia’s GDP, it faces a great challenge in ensuring adequate sanitation for its communities. The farm block areas are no exception as evidenced from what I saw as I travelled through selected parts of the district. One farm we visited was made up of 53 households with a population of 275, yet it shared just four latrines.
One might wonder how this comes to be. Farms are comprised of casual workers and permanent workers, but most farm owners build houses for only the permanent workers. The casual workers are forced to build their own houses and mostly do not build latrines. The housing is unplanned and is done in a temporary, disorderly manner. The workers move to the farms with their families, some farms hosting as many as 80 families.
The Luapula Province sits in Zambia’s northeast wing, nestled up against the Democratic Republic of Congo with Lake Mweru at its northernmost tip. It is a heavily populated area thanks to a rich fishing tradition and the fertile soil that supports the production of palm oil. For such a dense area though, the sanitary facilities in this area were few and open defecation was the common practice. The soil there is loose and sandy in some parts, making the construction of latrines difficult. There are longstanding cultural taboos that prevent the discussion of toilet use, and the idea of many people using the same place to defecate strikes many as uncouth. One of the main factors, previously unexplored, was the fact that the villages’ traditional leadership – figures such as village headmen and chiefs – had not been actively involved in pushing their villages to become open defecation free (ODF).
In my work as a Peace Corps Volunteer assigned to the Akros WASH Program, I was recently sent to the Chiefdom of Nalubamba in southern Zambia. We knew from our mHealth database that nearly 80% of the population there was living without adequate sanitation, meaning they did not have any form of toilet or hand washing facilities. I was with one of our community champions named Chris Malambo. He is in his mid 30’s and has the slender build of a Zambian farmer, working most days in the hot maize fields of his small patch of land in Chona Chiefdom. Chris had come along on this visit because there had been difficulty convincing the traditional chief of his villages’ sanitation problem. “We have our own reporting methods showing we have good sanitation and your reports are flawed!” the chief argued when we presented him with our data. Chris had shown a certain gift for changing minds and we would soon see his talents in action.
Indoor Residual Spraying (IRS) is one of the most effective tools in the fight against malaria. In Zambia, technicians enter dwellings once per year and spray the wall surfaces of buildings with insecticides that kill mosquitos who land on the walls and deter others from entering. Since mosquitoes feed in the evening and at night when humans are indoors, the spraying can greatly reduce the number of bites that occur.
But in rural areas like Zambia’s Luapula and Central Provinces, it is unclear how many dwellings exist, and where those dwellings are located. Without this information, deciding where to spray the insecticides is very difficult, the planners having no way to effectively target IRS to houses in areas of the highest malaria burden. While IRS remains one of the most effective tools for fighting malaria, the pesticides are expensive and must be targeted effectively.
So how to correct for this information gap? How to find out where exactly these dwellings are located so that they can be targeted effectively? Historically, if dwelling enumeration was done, it was done on foot, enumerators visiting villages in person, identifying houses visually and noting the GPS coordinates with a handheld device. It’s not hard to imagine that this method is extremely time-consuming and labor-intensive – especially for a large-scale enumeration. Zambia’s Ministry of Health (MOH), Ministry of Community Development Mother and Child Health (MCDMCH) and Akros technicians found a solution that is at the same time cost-effective and accurate, providing the pinpoint sort of data required for a more effective IRS implementation.