ELCZ Malaria Project overview

1. ELCZ Malaria Project overview

2. Introduction • Malaria still a major health problem in Zimbabwe • The Evangelical Lutheran Church in Zimbabwe’s (ELCZ) Malaria Project is contributing towards the fight against malaria and it’s socio-economic impact on the communities

3. Malaria In Zimbabwe • Zimbabwe has achieved steady gains in many malaria indicators. • Incidence has reduced from 136 people per 1000 population in 2000 to 22 people per 1000 population in 2012 • Mortality- from 3000 deaths per year in the early 2000s to 300 deaths per year in recent years. • Decrease is attributed to scaled up malaria prevention by the government and both international and local partners

4. ELCZ Malaria Project • LUCSA Regional Malaria Programme launched in 2010 • ELCZ one of the 5 initial countries to implement • Project started operating in Hwange and Gokwe North districts late 2010 • Focus was within the Church for both districts till end of 2011 • In 2012, the project expanded to the community in Hwange District targeting 5 rural wards and 8 urban wards. • In Gokwe district, political challenges were faced deterring the project to operate in the general community

5. Goal • Contribute to the reduction of morbidity and mortality due to malaria, particularly among pregnant women and children under- five as well as among vulnerable population groups

6. Strategic Priority Areas The Four Pillars Institutional Capacity Building Malaria prevention, control and management Treatment Sustainable Livelihood

7. OUR APPROACH BEHAVIOUR CHANGE –CENTRED PROGRAMMING HOUSEHOLD AS A UNIT OF PRACTICE

8. Targeted Population • 2 districts out of 63 districts in Zimbabwe • Gokwe and Hwange Districts • Among top 20 malaria burdened districts • Out of the 63 districts, 45 are malaria burdened districts

11. Project Interventions & Achievements • Institutional Capacity Building • Trained 100% of Pastors and 88% of Church leadership in all 3 dioceses on mainstreaming malaria • Trained all targeted congregational committees on malaria prevention and control • Community structures initiating programmes to prevent malaria and manage the environment • 6 Focal Persons • 19 Community Health Workers • 11 Ward health teams • 3 Community clubs • 33 Champions-neighbours keepers • 3 Advocacy Groups • 16 School Health Clubs

12. Pillar 1:Institutional Capacity Building • Other Churches working with the project duplicating some components of the project in their congregations • Even Apostolic sects which used to refuse treatment are now subscribing to it.

13. Pillar 2: Malaria Prevention and Control

14. Behaviour Change Communication • Community structures raising awareness and disseminating information for behaviour change • Community structures as sources of information within communities. • Pamphlets and posters used to disseminate information • Information through songs, drama, talks, campaigns, home visits

15. School Health Promotion • 26 Schools working with Project • 23 School health clubs • 24 School Health Coordinators trained • 10 Schools with First aid kits • 10 Schools testing and treating malaria

16. School Health Clubs

17. Net use campaign • Communities encouraged to use mosquito nets properly and consistently • Demonstration of net use conducted by Focal persons during health talks • Door to door campaigns for Long Lasting Insecticidal Net (LLIN) use • Partnership with PSI for proper net distribution

19. Environmental Management • Environmental management awareness campaigns • Communities organising themselves to manage the environment for malaria control • Project provides cleaning equipment e.gslashers, rakes etc • Project volunteers working with a Government arm-Environmental Management Agency

21. Indoor Residual Spraying • Mobilisation for IRS • Intensive behaviour change communication • Door to Door visits • Malaria Champions monitoring compliance • Project supporting with protective clothing and fuel • There has been an increase in the percentage population protected by IRS in Hwange district as shown by the graph below

22. IRS Statistics

23. Pillar 3:Treatment • There has been a downward trend on morbidity and mortality in the targeted clinics • Excessive rains might however pose a threat of outbreaks this year. • 24 School Health Coordinators trained in RDT testing and treating • 10 Schools testing and treating malaria • 5 Village Health Workers testing and treating • Awareness on the need for early treatment seeking

24. Treatment

25. Malaria Trends

26. Malaria Trends

27. Intermittent Preventive Treatment • Health talks with women and men of child bearing age • Behaviour Change Communication on IPT • Increased uptake of IPT • Graph shows % of registered pregnancies receiving at least 2 doses of IPT

28. IPT Trends

29. Pillar 4:Sustainablelivelihoods • Livelihoods projects started in December 2012 • Aim is to reduce poverty which hampers malaria prevention and control • Pillar is 3 legged • Capacity building for livelihoods • Income generating projects • Village Saving and Lending Schemes

31. Sustainable Livelihoods • In Gokwe-Chemical supply shop doing well • From June to December 2013, profit was $2500 • 2013 closing stock value was $4 500 • In Hwange-Nutritional garden doing well • Supplying local restaurants and OK shops with vegetables especially lettuce

33. Income Generating Projects

34. Climate Change Coping Mechanisms

35. Nutrition garden

36. Most significant changes • Improved IRS coverage • There is a marked increase in IRS acceptance in the rural areas. In Milonga, the rate rose from 64%in 2012 to 98% in 2013. FelistasChuma, one of the malaria champion,ssays that even those people that used to deny the spray operators access to their rooms on grounds of allergies and asthma have changed their attitudes towards IRS

37. MSC • Improved consistent and correct net use • According to Mrs Lydia Nkomo, a Malaria champion, there is an improvement in consistent and correct net use in the communities. The positive attitude towards nets has been evidenced by the demand for nets by the entire communities. Those that had failed to get nets during the distribution went to health centres to ask for them.

38. MSC • Involvement of community leadership in malaria awareness • “Village heads are taking the lead in malaria campaigns and whenever they have their community meetings they start by discussing malaria issues. They are actually advocating for the punishment of LLIN abusers through the Chief.” Gideon Ndlovu (a villager)

39. MSC • Improved household income • Simkhulekele Ndlovu, a VSAL member says that there is a great improvement in her household diet. Before joining the savings and lending scheme, her children had challenges in having food to carry in their lunch boxes to school. They used to carry some corn snacks and water. After joining the club she is now able to do small household income-generating projects that gives her money to buy food for her children. Instead of corn snacks they now carry bread with butter and juice and sometimes they carry bread with a sausage. The savings have increased their household income.

40. Household diet

41. MSC • Improved Household Income • I joined the savings and lending in 2013 after we were trained by E.L.C.Z . From the time I joined the club my life has changed so much. I have been borrowing money from the club and doing small household income generating projects. My main IGP is on buying items from South Africa and selling them locally. Lately I have been buying portable DVD/TVs and selling them here in Victoria Falls. These small DVD/TVs can use both electricity and batteries so I thought I can make business if I sell them in our locality where there is no electricity since it’s a new suburb. People are using batteries which they can buy from the shops. From this business of buying and selling I have managed to buy my household property which includes the wardrobe. I bought this wardrobe from Botswana. I am very grateful for what savings and lending has done for me and I am not going back

42. Household assets

43. Household IGPs

44. Human Interest Stories Changed Behaviours • A kraal head in Madzivazvido Mr Kufa who has 3 wives said when the IRS spraying team came to his village in September, he was at the shops and heard that all his wives had locked houses and left for the garden. This was to deter spray operators from spraying. • Each year they would complain that the chemical used left their walls dirty. “When I heard about this , I ran home and opened all the rooms to let the spray operators do their job even on top of the wardrobes”. He said he has realized the importance of IRS in malaria prevention, thanks to ELCZ malaria project. • “When they returned from the garden, they were very angry about what I had done, but I had to tell them never to re-plaster those walls for the next 12 months” • Mr Kufa stated that they have never experienced deaths due to malaria in their village for the past 3 years and he expressed that he thought this was due to the introduction of the IRS programme

45. Human Interest Stories

46. 2014 & 2015 plans • Intensify implementation in Gokwe • Intensify pillar 3 and 4 in Hwange • Maintain partnership with community structures for sustainability • Use of influential people for behaviour change (Malaria Ambassadors) • Focus more on VSALS instead of high input IGPs • Utilise the already circulating seed money for IGPs

47. Source of motivation • Spiritual background • Called to save others • The smiles • Improvement in lives • Contributions of others e.g ELCA members • Team work is the fuel that allows common people to attain uncommon results-Andrew Carnegie

48. End of presentation • Individually, we are one drop. Together we are an ocean • Thank You • Tatenda Prepared by Y.Muzezewa

49. Q and A! • How do you celebrate World Malaria Day? • Last year: we commemorated for a whole week. We wanted to raise awareness on the importance of nets, because we knew PSI was coming with nets later. So we raised awareness, did demonstrations, an door-to-door visits. 98% of target households were reached! Partnered with gov’t. Zimbabwe/Zambia malaria initiative was launched. There were banners, singing, exhibits, net demonstrations, demonstration son how to take the malaria medicine, demonstrate local shrubs that keep away malaria, dramas, talk by bishops.

50. Q and A, cont. • World Malaria Day, cont.: • This year: . School tournaments: soccer and netball. School health clubs wear T-shirts will malaria messages, do talks. Also door-to-door visit. • High grasses: can mosquitoes breed in dry grass, or just wet? • - Would have to be wet grass. Standing water is the main breeding ground, especially clear standing water.