Chief Mukobela is one of the first chiefs to attain open defecation free status (ODF) for his chiefdom in Zambia. Having attained ODF status in 2013 after the community led total sanitation programme (CLTS) was introduced in 2012, His Royal Highness has gone beyond and has begun working on a sustainable approach to maintain adequate sanitation in his chiefdom. He has since begun partnering with the Government of Zambia and Akros in ensuring that sanitation marketing and school-led total sanitation is a reality in his chiefdom, an indication of his great commitment towards stopping open defecation.
To many chiefs in Zambia, attaining ODF status in their chiefdom is seen as a challenging process. This has been attributed to the deep-rooted cultural behaviours that prevent them from defecating in a toilet. These behaviours are said to take a process to unlearn.
Some chiefs have even gone to the extent of putting up stringent measures aimed at ending open defecation such as charging a fee to subjects who refuse to comply with building a latrine as well as threatening them with the law.
Akros has recently begun partnering with university graduate programs to offer practical knowledge and experience to students with an interest in health around the world. Annie Glover, a Masters student in Public Health at the University of Montana in the United States is one of those students, and has been in Zambia for the past month. “I have always wanted to pursue public health, meet new people, experience new culture and give back to society” said Glover.
Annie’s time in Zambia was spent learning the intricacy of the work community health workers and volunteers do. Her work also involved identifying avenues that Akros can use in collaborating with other like-minded organisations in order to increase its efficiency and effectiveness.
A group of 16 high school students and 5 teachers recently visited Akros as part of their learning expedition. The students, aged between 15 and 17, are part of the Traveling School, based in the U.S. The group of 16 young women spent a day between the Akros offices and the National Malaria Control Centre to gain a better understanding of Akros’ involvement in building healthy communities. The visit was also meant to bridge the gap between classroom knowledge and practice.
Various members of the Akros staff told the story of Akros’ history, areas of focus and mission. The young women learned about Akros’ on going work supporting disease surveillance, and received some information on international career track approaches. The enthusiastic students were then given a presentation on malaria and its lifecycle. After the presentations at Akros offices, the girls were taken on a tour to the National Malaria Control Centre where they got a chance to see how the lab plays a significant role in the fight against malaria. They were taken through the process of how the polymerase chain reaction (PCR) is used in the detection of low-density malaria infections that the rapid diagnosis test (RDT) and microscopy can sometimes miss. Students also got the opportunity to learn how an RDT works.
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).
The Akros WASH team has been recognized again for their work in the Community-Led Total Sanitation Program. The May issue of the Zambia National Sanitation Programme’s newsletter contributes the entire first page to highlighting the progress in sanitation health across the country spearheaded by the Akros team.
In an excerpt from the newsletter, the author writes:
Akros developed an innovative and concise surveillance platform using low-cost mobile phones combined with simple protocols for reporting and analysis – protocols which could be easily managed by local counterparts. The protocols and tools were piloted in September of 2013, then rapidly scaled through October and November. … These numbers are impressive, in fact unprecedented, for the sub-Saharan Africa region. Even more impressive is that the Akros WASH team has achieved these gains at a fraction of the normal cost for CLTS management.
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.
The University of the Western Cape (UWC) School of Public Health in cooperation with The Mauerberger Foundation established an award in 2013 to honor the memory of Jakes Gerwel, the university’s late Vice Chancellor. Before joining the university, Gerwel was Director General in the office of Nelson Mandela’s presidency. Each year the award honors a graduate of the school for the outstanding work he or she has demonstrated in the field of public health.
Anne Mutunda, a Water & Sanitation Health (W.A.S.H.) Surveillance Officer with Akros, is being honored as a nominee for the work she did during her MPH studies at the university. The qualitative study, undertaken in 2012, was initially seen as an exploration of the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in secondary schools in the Mongu District of Zambia’s Western Province. Mutunda recognized a situation where menstruation has been, and still is a taboo that is dealt with in secrecy, information and knowledge about menstruation and menstrual hygiene among adolescent girls being inadequate as a result.
During the process of the study, however, Mutunda would find that there would need to be a clear focus on the anticipated knowledge gap and the associated traditional cultural factors influencing menstrual hygiene. There was also a strong focus on the socio-economics, both of the girls individually and the schools they attended. The poverty in which they lived meant that the girls had no access to the basic necessities of sanitary towels, instead using torn bits of rags or toilet paper. Even more significantly, a lack of water and sanitation facilities at home and at the schools made even the most basic hygiene practices impossible.