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Zambia's successful SALT response to COVID-19

Evidence from Zambia shows that COVID-19 can be combatted using SALT.

In particular a report [PDF 2.6MB] from a 2020 project shows that local people made observable changes in their behaviours and attitudes to reduce the risks of virus transmission. Previously there was widespread disbelief that COVID-19 even existed, was present in Zambia, or was a problem. Sound familiar?

True to form the SALT response was generated locally and fits local needs – at relatively tiny cost. Localness was illustrated by the ways in which funerals and football were significant, and the many responses to those issues. To name just a few:

• Preachers were to reduce their preaching during funerals to 10 minutes.
• Teams were to buy enough football jerseys so that every player has their own and exchange of clothing is stopped.
• Diversional therapy was to be identified for children and young people who would otherwise have been playing football or going to school.

As the second wave sweeps through Zambia the urgent need is to transfer the benefits to the rest of Zambia and beyond. The mechanism – Transfer – is already in-built as the T of SALT and the local people are somehow just doing it. Even modest extra resources, however, would help, especially money for petrol.

• The first Chiefdom transfer to neighbouring Naluama Chiefdom is happening via a facilitation team visit from Mapangaya (ie Chieftainess Mwenda's location).
• Other Chiefs are gathering from the surrounding parts of Southern Province.
• It's a big job – there are hundreds more Chiefdoms (see list).

It is tempting to ask 'so, are there fewer deaths?' However, that is the wrong question. A better question might be 'how much has COVID-19 responses cost your country and how well have behaviours changed there?' Little is gained anywhere until local people acknowledge the issues and act. Only once they are thus engaged can they monitor effectiveness and adapt their responses. SALT results in behaviours adapting.

The local-global response to COVID-19 in Zambia illustrates SALT's power.

The project itself was confined to one rural Chiefdom, that of Mwenda, covering about 65,000 people and villages. It was a three-month initiative that was launched in late August.

Back in March 2020 Ian Campbell and Zambia's Elvis Simamvwa discussed how Zambia could respond to COVID-19. The response would be Zambia-wide and would embrace SALT practice and the development of facilitation teams.

At first they focused on the Churches Health Association of Zambia (CHAZ), which each of them had previously chaired. Via CHAZ over 60% of the Zambian population is reachable. However, at the time CHAZ was preoccupied with the challenges of supplying and distributing personal protective equipment, as were other national faith and development entities.

So Elvis called their old friend Ellie Kalichi – she is now the Chieftainess of the Mapangaya area (in Zambia's Southern Province) and represents about 60 villages and about 60,000 people. Some weeks later Ellie asked for Ian to call her.

Ellie told of her concern for her people because of government-ordered lockdown. Two weeks earlier, despite movement being prohibited, she had arranged for her and her entourage to visit three villages. As the Chieftainess she had the authority. No other district leader from police, government or faith group could do it for fear of punishment by law.

She had found fear confusion and conflict about COVID-19. Infection numbers in the country were low [and in early June remain low], but the trajectory was unknown. The people had little water for drinking let alone for handwashing to contain COVID-19.

Ellie and Ian agreed that the people should proactively refer people with Covid symptoms to local health centres for further assessment, and should engage in testing and contact tracing when it becomes available. And, the people should partner with the local Chikankata Hospital (which is designated as a key Provincial COVID Center) and the District Health Office. [Zambian administration is structured by a heirarchy of Provinces, Districts and Wards - but the real influence comes through Chiefdoms, the boundaries of which align differently.

Ellie's confidence was built on her previous experience of community responses to leprosy, TB and HIV – and her actions go far beyond raising awareness.

Local coordination was ready, and Ian successfully sought from the USA a modest grant for community counselling and leadership engagement. Those funds were supplemented by a small amount from Australia – enough to pay for some petrol.

The grant covered systematic community counselling for three months with 60 villages by a mobile team drawn from the Chiefdom. The team included people from local church, health facilities (both mission and government), local government, and the district health office.

The three main indicators/outcomes expected were:

• local action by villages Covid teams for prevention and care
• confidence in referral
• engagement in some way in contact tracing when it emerges.

The impact was to include renewed confidence and plans of the local communities for action in the future, and the part they could play in the district/ national response to the next epidemic whatever it would be.

The above aims were quickly achieved. By September three sub-teams had covered 300 villages by intense travelling and community conversation. A core indicator of the change being achieved was that 80% of pepole now believe that COVID is real – whereas at the start of September only about 5% believed it. The villages were owning their own response and were actively planning.

The initiative was initially local, and by mid-October was also starting, as envisaged, to show the way to others both in Zambia and beyond. The core team was gathering the village COVID teams – calling them Covid Prevention Teams – and motivating them to reach out laterally to nearby communities. This is happening after a 'mini' learning synthesis. They were heading in the right direction.

The local team budget was modest and sufficient for the first three months (June to August). The reflection on the significance of faith and community relationship in shaping the overall response was really important. Ian had hoped that it could happen and gives thanks that SALT practice yet again delivered what it promises.

The current need

A modest amount of extra funds would go a long way. If you can help, even a bit, then please let us know.