Come Drought or High Water: Adapting to Climate Challenges While Combatting Malaria in Zambia

A Changing Climate in Zambia

I grew up in a mining town in Zambia’s Copperbelt Province, where I assumed our proximity to the Congo Basin rainforest would maintain the predictable rainfall pattern that defined my childhood. Now, decades later, there is no denying the increased frequency and intensity of extreme weather events because of climate change.

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Author Presley Musonda (left) with U.S. Global Malaria Coordinator Dr. David Walton in Zambia.

Photo Credit: Jennifer Somtore, President’s Malaria Initiative

Today, Zambia is experiencing the worst drought in 20 years. Temperatures have increased, more than 6 million people (31 percent of the population) need help accessing food, and there is a power crisis caused by water levels falling in the hydroelectric dams on which Zambia relies for 80 percent of its electricity. 

Drought-induced power outages, lasting up to 20 hours a day, impact the quality of care at health facilities. For example, health facilities depend on an electronic logistics management system to record medicine consumption and order new supplies. Without power, health workers face delays in reporting, leading to stockouts of essential medicines at health facilities despite their availability in the central warehouse. Extreme weather like rising temperatures and flash floods may also increase the risk of malaria transmission by shifting the geographical distribution of both the vector and the parasite and complicating the delivery of key interventions. 

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A team delivers essential health commodities, such as antimalarial drugs, to hard-to-reach areas on islands ahead of the rainy season in Zambia. Crossing to the islands with boats loaded with supplies would be extremely challenging during the peak rainy season.

Photo Credit: Visio Coulture

Climate Action to Strengthen Malaria Programming

The President’s Malaria Initiative (PMI) is the U.S. Government’s largest program leading the fight against malaria. Established in 2005, PMI partners with 27 countries in sub-Saharan Africa and three programs in the greater Mekong subregion of Asia. 

Zambia is one of the many PMI partner countries experiencing changing weather patterns affecting its malaria control programs and putting more people at risk for malaria. In response, PMI teams around the world are supporting National Malaria Programs to adapt programming as needed to achieve our shared goal of a world free of malaria.

The timely release of PMI’s first Climate Framework in April 2024 provided an invaluable guide to help us address the impacts of climate change on Zambia’s malaria programming. Now we are further adapting malaria interventions to improve resilience in the communities we serve.   

PMI works hand-in-hand with Zambia’s National Malaria Elimination Centre. The Centre convenes partners, including the Zambia Meteorological Department, to review malaria and climate data to predict seasonal patterns that affect malaria transmission. This information guides adaptations to malaria programming, including the timing of malaria prevention interventions such as spraying of insecticides in homes and distribution of insecticide-treated bed nets. 

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A vehicle carrying bed nets as part of a mass distribution campaign reaches the limits of safe operability in Western Province, Zambia, in 2023. Heavy rains present significant operational challenges, demonstrating the importance of pre-positioning supplies to flood-prone areas.

Photo Credit: Chiti Nseluka, USAID Global Health Supply Chain Program-Procurement and Supply Managementt

For example, in March 2023, the National Malaria Elimination Centre and its partners analyzed climate data to predict when the rainy season would begin in flood-prone communities. This enabled the Zambia Medicines and Medical Supplies Agency, in collaboration with USAID, to pre-position essential medical supplies to 140 health facilities from October to November 2023, ensuring Zambians had continuous access to lifesaving insecticide-treated bed nets and medicines even when roads became impassable due to flooding. Community health workers in these areas were given several months’ worth of malaria tests and treatments before the rains began so they could continue to care for community members.

Furthermore, we were able to immediately pivot and adapt to the drought-induced power crisis. PMI transitioned to providing battery-operated solar lamps and solar chargers to ensure that key entomological surveillance activities such as mosquito collection, microscopy, and data entry could continue even in the face of extreme weather events. Additionally, PMI will provide solar-charged power banks for community health workers to ensure continuous electronic data entry and reporting. 

On the mitigation side, the PMI team switched from air freight to ocean freight for shipping all internationally procured malaria commodities into Zambia, resulting in cost savings and a reduced carbon footprint for commodity transport. We have also opted to use bicycles during insecticide spraying campaigns to reduce the emissions of greenhouse gasses through vehicles and fuel.

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Spray operators travel by bicycle to spray homes with insecticide.

Photo Credit: Chikondi Mvula, President’s Malaria Initiative Evolve

Getting Back on Track to End Malaria

Since becoming a PMI partner country in 2008, Zambia has made significant progress against malaria, including cutting child death rates in half. I am optimistic that Zambia can protect these gains by adapting malaria programming and interventions to become more resilient in the face of changing weather patterns and extreme weather events. Through the climate-smart leadership of Zambia’s National Malaria Elimination Centre, we are already seeing the benefits of sharing climate data to make evidence-informed decisions to adapt malaria interventions. I pledge to do my part to adapt as needed, reduce greenhouse gas emissions, and get back on track to end malaria for the benefit of my children and all Zambians.