Africa: Countries With Free Primary Healthcare More Successful in Malaria Fight #ZeroMalaria

23 April 2021

Johannesburg — "As we commemorate World Malaria Day this year, we must remember that this is a disease that is preventable and treatable and yet it kills more than 400 000 people every year. We have made huge strides in combating this global killer but lately progress has plateaued, particularly in countries with a high burden of diseases, we have missed critical targets of the global malaria strategy, at the same time we have made great strides with many nations now on the role to eliminate malaria," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

The theme for this year's World Malaria Day is "Zero Malaria – Draw the Line Against Malaria" because every malaria case is preventable, and every malaria death is unacceptable. Ahead of World Malaria Day 2021 on April 25, The World Health Organisation (WHO) announced the launch of the E-2025, a new elimination initiative that builds on the foundation of the E-2020. A set of 25 countries has been identified with the potential to eliminate malaria within the next five years.

In 2016, WHO identified a group of 21 countries, across five regions with the potential to reach this milestone. In 2017, the E-2020 initiative was launched by WHO, which supported these 21 countries in their efforts to achieve zero indigenous cases of malaria within the 2020 timeline. Cabo Verde, El Salvador, Algeria, South Africa, and Sri Lanka were among the 21 countries. While some countries did not meet the 2020 elimination goal, they remain committed to ridding their populations of this disease.

"Twenty-four countries have succeeded in reaching zero malaria transition for three years or more and in total, 38 countries and territories have been certified malaria-free by WHO, including most recently, El Salvador, Algeria and Sri Lanka. Many of these countries once had a high burden of malaria and achieved the hard-won success after decades of action. Today we recognise and celebrate their achievements which were routed in the unwavering political commitment to end malaria, marked by sustained funding that sustained preventive efforts even after reaching zero," said Tedros.

The WHO chief said a common trend for most of these countries is that they have invested in free primary health care and robust health information systems and recruited networks of volunteer health workers to prevent, detect and treat malaria even in remote areas.
"These countries have shown that malaria elimination is a viable goal for all countries no matter how far they may be from the ultimate target. They are an inspiration for us all," he said.

Though malaria is preventable, the African region still accounts for most of malaria deaths. In 2020 there were 384,000 deaths in the region. In 2019, the region accounted for 94% of both the 229 million malaria cases and 409,000 malaria deaths reported globally.

"I would like to call on all stake holders to draw the line against this disease because all malaria cases and deaths are preventable. Between 2000 and 2019, malaria incidence declined by 29% and deaths by 60%. More than 1.2 billion cases and 7.1 million deaths were averted in the region. Cabo Verde has maintained zero malaria status since 2018, Algeria was certified malaria free in 2019, and Botswana, Ethiopia, the Gambia, Ghana, Namibia and South Africa achieved the 2020 milestones of reducing malaria incidence and deaths by 40% compared to 2015," says WHO Regional Director for Africa, Dr Matshidiso Moeti.

Moeti says the region still faces many challenges and has a long way to go, as it did not attain the 2020 malaria milestones. She also acknowledges that while new cases dropped by over 9% every five years, between 2000 and 2015, in the last five years this progress has stalled with incidents dropping by less than 2%.

Dr Akpaka Kalu, Team Lead at the Tropical and Vector Borne Diseases in the WHO African region, said what is behind these numbers is the fact that access to malaria prevention and treatment is still limited.

"It is unacceptable that 67% of pregnant women are not getting the treatment they need. 32% of households do not have a single net. We must ensure that malaria prevention is scaled up to universal coverage. Everybody must have access to an insecticide-treated net to sleep in, in a malaria-endemic area. Access to testing and treatment of malaria cases should be enhanced, Where there are no health facilities community-based management of malaria should be introduced, now is the time to drive malaria to zero by jointly working together at a community level, at a district level and at a national level. It is time for the whole of society to come together and deal with the malaria scourge in Africa," Kalu said.

One of the biggest challenges faced by African malaria endemic countries is poor financing for malaria prevention and treatment services for populations. Malaria is responsible for an average reduction of 1.3% in Africa's economic growth every year. Malaria related absenteeism and productivity loses costs Nigeria, for example, an estimated U.S.$1.1 billion every year.

Moeti said to tackle the social and economic impacts of this disease, more needs to be done to ensure that life serving, cost effective interventions reach at-risk communities. She also says innovations will be critical to speed up progress towards zero malaria.

"As of 2019, 1 in 3 at-risk households in the region did not have an insecticides bed net and nearly half of the children under the age of 5 did not sleep under a net, two thirds of pregnant women did not receive malaria preventable treatment and without this protection more than 11 million pregnant women got malaria and 820 000 new born children had low birth weight. We are excited that Ghana, Kenya and Malawi have delivered more than 1.7 million doses of the RTS,S vaccine. This is a promising additional tool in malaria prevention.

"As WHO, we are working with countries to look strategically at the recent stagnated progress and see how to get back on track towards the 2030 targets. This starts with moving from seeing malaria as only a health problem to understanding that this disease is a threat to socio-economic development, and it requires a multi-sectoral response. With all of society action to draw the line against malaria, together we can ensure that African individuals, families and economies prosper," Moeti said.

In 2019, Malawi became the first country in the world to introduce the malaria vaccine into its childhood immunization programme, followed by Ghana and then Kenya.

According to the report of the 87 countries with malaria, 46 reported fewer than 10 000 cases of the disease in 2019 compared to 26 countries in 2000. By the end of 2020, 24 countries had reported interrupting malaria transmission for 3 years or more. Of these, 11 were certified malaria-free by WHO. The report states that most countries that succeed in eliminating malaria offer free primary health care, ensuring that all people in need of malaria services can access them without financial hardship. Robust data systems and the engagement of communities were some of the key drivers of this success.

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