COMMEMORATING WORLD MALARIA DAY April 25, 2017

World Malaria Day this year will be commemmorated by highlighting the commendable strides that have been made across the SADC region towards eliminating malaria, with the theme “End Malaria for Good”.

His Majesty, King Mswati III of Swaziland, was recently appointed as the Chair of the African Leaders Malaria Alliance (ALMA), in recognition of his country’s model performance and progress towards malaria elimination. As Chair of the Southern African Development Community (SADC), His Majesty has committed his leadership to the ambitious move to eliminate malaria from the SADC region, setting the stage for the gradual rolling back of malaria throughout Africa.

Malaria Elimination Strategy for SADC

The complete elimination of malaria has been deemed an ambitious and over reaching goal that the Southern African Development Community (SADC) has set out to achieve. This ambitious goal however, is looking more and more promising to attain through mechanisms set in place and policy restructuring designed to particularly address the interruption of malaria transmission.

Malaria elimination is the interruption of local mosquito-borne malaria transmission in a defined geographical area. Attaining malaria elimination in a particular country means that there is no local transmission of malaria occurring within that country, although there may continue to be cases of malaria that are imported from outside the country; these need to be identified and acted upon to prevent triggering of onward infection in the country that has eliminated.

Eliminating malaria therefore involves three key concepts:

a. Parasite clearance, largely through drugs or a vaccine (a malaria vaccine does

not yet exist, but some promising vaccines are under development);

b. Keeping out the mosquito vector that facilitates transmission (such as spraying

techniques) or blocking it from biting (such insecticide-treated nets or

repellents);

c. Minimizing the importation of the parasite that can be imported through human movement.

The SADC Region has demonstrated and reaffirmed its commitment to improving the health of its population. Articles 9 and 11 of the SADC Protocol on Health (Maputo, August 1999) call upon Member States to harmonize and standardize policies pertaining to malaria control for efficient use of resources, and harmonization of goals and interventions for the effective control of malaria.

The first Abuja Declaration, signed on April 25, 2000, committed African Heads of State to halving malaria deaths by 2010, provide financial resources and incentives to access goods and services, and support malaria research. The second Abuja Declaration, signed April 24, 2001, committed African Heads of State to allocating 15 percent of their national budgets to health as well as mobilizing resources for improved access to HIV medications, vaccine research, and prevention programs.

By 2007, during the third session of the African Union (AU) Conference of Ministers of Health, member states launched the Africa Malaria Elimination Campaign, committing to transition eligible countries from malaria control to malaria elimination. Later that year, the Southern Africa Development Community (SADC) followed suit, similarly pledging to eliminate malaria from southern Africa. The SADC Ministers of Health approved the SADC Malaria Strategic Framework and subsequent Malaria Elimination Framework which urged member states to identify potential areas for elimination and to develop national malaria elimination strategic plans. African Heads of State, in 2016, went further to endorse a goal of an Africa free of malaria by 2030.

The SADC sub-region has set itself objectives for achieving malaria elimination, and has identified these key requirements for the success of this program:

i) Sustainable financing: sustained and predictable levels of financing provide stability and consistency to malaria interventions. When countries have experienced a decline in funding, malaria has resurged, eroding the gains of previous investments made.

ii) Multi-sectoral approach: Increased interagency collaboration within national governments (ministries of health, finance, agriculture, environment and tourism) play a critical role in the national drive towards elimination.

iii) Cross-border collaboration: Population movement across SADC borders facilitates importation of malaria from more highly endemic countries, into lower transmission areas that are aiming to eliminate transmission. Cross-border diplomacy to facilitate sharing of information on transmission patterns and high-risk populations is an important element of a collaborative regional elimination strategy.

iv) Regulation: Malaria elimination is a complex and ambitious programme, relying on constant innovation and redesign of programmes to catch up with the ongoing disease intelligence. Bureaucracy often causes lags in the introduction or adoption of new medicines, new operational systems, or policy guidelines. Malaria programmes will benefit from government regulation that mandates compliance with the malaria elimination strategy by various actors, expedited review and approvals of new policies, as well as waiving of some regulatory practices that constrain innovation.

v) Human Resource development: National malaria programmes are often understaffed and struggle to identify expertise for some specialist roles such as entomology and parasitology, and epidemiology.

SADC Elimination 8 Initiative

The SADC Elimination 8 (E8), an eight-country initiative of the SADC Ministerial Committee, is a sub-regional platform for malaria collaboration, in line with the malaria elimination vision of SADC. The overarching concept of the E8 regional strategy is the interconnectedness between countries, which inherently undermines any country’s prospects for independently attaining malaria elimination. The E8 operates within the framework of SADC Protocol on Health, the Malaria Strategy and the SADC Malaria Elimination Strategy. It aims to create an enabling regional environment that will allow the eight respective countries to achieve their elimination goals, thus accelerating progress towards a malaria-free southern Africa.

Established in 2009, eight SADC country Ministers convened to develop specific mechanisms for cross-border collaboration to accelerate the pace towards malaria elimination. The eight countries represent the countries that fall along the current boundary of malaria transmission within southern Africa. Namibia, Botswana, South Africa, and Swaziland are the “frontline” countries, expected to be the first to eliminate malaria by 2020; these four banded with their neighbours (Angola, Mozambique, Zambia, and Zimbabwe), whose common borders represent a technical and strategic opportunity to collaborate in order to minimize cross-border importation of malaria. There is now unprecedented momentum towards the ambitious goal of malaria elimination in southern Africa.

The E8 Regional Initiative is an unprecedented approach that aims to end transmission in the four low-transmission “frontline countries” by 2020 and to pave the way for elimination in the four middle- to high-transmission “second line countries by 2030. Notably, two of these second line countries, Zimbabwe and Mozambique have adopted a sub-national elimination strategy and parts of the countries’ districts are now in pre-elimination. The E8 is therefore a pioneering collaboration that provides a blueprint for other countries and regions seeking to eliminate malaria.

Within the E8, member countries collaborate to address challenges that go beyond the scope or mandate of any one country, such as those associated with mobile and migrant populations, and gaps in surveillance data, resources, and infrastructure. The E8 is led by its member countries’ Ministers of Health and is supported by a Technical Committee, E8 Ambassador, and a Secretariat in Windhoek, Namibia. The E8 is currently funded by the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the Global Health Group at the University of California, San Francisco through a grant from the Bill & Melinda Gates Foundation.

Accelerating Elimination Efforts

Through collaboration with member states, technical partners and donors, the E8 is dedicated to regional policy harmonization and alignment with the SADC malaria elimination strategy, in order to eliminate malaria from the region by 2030, through:

• Regional policy harmonization and establishment of minimum technical and

implementation standards

• Regional surveillance, monitoring, and accountability

• Increased assess to diagnosis and treatment for mobile and migrant populations

• Advocacy for sustained domestic investment and external financing support

Roll-Out of Border Health Posts

In an effort to contain the challenge of cross-border importation of malaria, which serves as a risk to malaria elimination efforts, the E8 ministries of health are rolling out a set of malaria static and mobile border posts across the sub-region. These will operate as an extended system of community and other health workers expanding access to early malaria diagnosis and treatment amongst mobile populations as well as underserved border communities. It is expected that this initiative will reduce malaria transmission in the border regions and reduce importation of malaria from high to low burden countries.

A Letter from the E8 Ambassador and E8 Chair

Fighting southern Africa’s malaria outbreak together today will secure prosperity tomorrow Hon. Minister Sibongile Ndlela-Simelane, Elimination 8 Chair and Minister of Health of Swaziland -and- Dr. Richard Nchabi Kamwi, Elimination 8 Ambassador, Champion of the  African Union’s Centre for Disease Control and Prevention, and former Minister of Health of Namibia

Southern Africa, which in recent years has made large strides against malaria, is currently experiencing a series of alarming malaria outbreaks. Six southern African countries have recorded a significant increase in malaria cases, with some countries citing a four-fold increase in cases from the same period last year. In Botswana and South Africa, cases of malaria are being reported in areas that had previously eliminated the disease, and outbreaks have been officially declared in parts of Botswana, Namibia, and Zimbabwe.

What has caused the malaria outbreak in the region? An analysis is underway, but we know that the region’s unrelenting rains and flooding have propagated mosquito breeding sites and have displaced communities, limiting access to malaria services. The previous four years of drought gave us favorable conditions for progress toward elimination, some of which has now been undone by the rain. Low quality and low coverage of indoor residual spraying (IRS) – the main preventative measure in almost all of the E8 countries—is  likely confounding the situation.

Given the region’s vulnerability to climate change and the likelihood of alternating periods of heavy rain and drought in the future, an examination of what we can do differently will enable us to adapt our methods to volatile climactic patterns and prevent future outbreaks. Today’s situation has highlighted the need for stronger surveillance and early warning systems, greater coverage of malaria prevention and treatment in areas that need it the most, and improved coordination and data sharing among neighboring countries. If we are to eliminate malaria, the association between rain and malaria outbreaks must be broken. We can do more to ensure that rain no longer results in an increase of malaria.

The current outbreak poses serious threats to the health and socioeconomic status of the affected countries, and the risk of resurgence cannot be understated. But all is not lost. Several of southern Africa’s malaria-endemic countries have made remarkable progress against the deadly disease. Building on previous gains, national malaria control programmes have rallied under the banner of the Elimination 8 (E8) Regional Initiative, an extraordinary endeavor to jointly and progressively achieve regional elimination.

The current malaria outbreak has already demonstrated the value of the E8 collaboration. At an emergency E8 meeting convened last month, Ministers of Health and national malaria control programme managers came together to analyze the latest developments, share learnings, and develop a joint action plan for a regional early warning system. Joint investments like the regional database and early warning system will inform timely and strategic deployment of resources to the worst affected areas. In this way, the outbreak, while revealing some areas of programmatic weakness and vulnerability, offers great opportunity for the E8 to fulfill its mandate of knowledge sharing and collaborative problem solving.

In the event of a multi-country malaria outbreak– when information is power, resources are limited, and time is of the essence—engagement, transparency, and collaboration between programmes are critical. Now more than ever, the E8 countries must rely on each other for timely, accurate information to prevent, detect, and contain the spread of malaria. As malaria programmes from Angola to Mozambique combat the outbreak on the ground, the E8’s unique platform for regional coordination and data sharing will accelerate progress toward the shared vision of a region free of malaria. The combination of regional coordination, community engagement, and individual actions to prevent malaria will be instrumental in ending malaria for good.Fighting the malaria outbreak today will secure regional health, security, and development for years to come.

Key Commemoration Activities Planned for World Malaria Day, 2017

• World Malaria Day celebrations in  Swaziland, as part of King Mswati’s birthday celebrations, (April 24)

• Launch of border malaria post in Mozambique, Namaacha, (April 25)

• World Malaria Day Commemoration in Zambia, (April 25)

• Signing of bi-lateral partnership MOU on  cross-border malaria control between  Zambia and Zimbabwe, under the name Zam-Zim Cross Border Malaria Initiatve, (April 27)

• Trans-Kunene Malaria Initiative (TKMI) bilateral partnership commemoration, along Angola-Namibia border

April 2017
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