On 4th of June 2024, the African Constituency Bureau organized a webinar, “Empowering Africa: Collaborative Malaria Actions”. In all, 85 participants across the African constituencies and the technical partners gathered to deliberate on the malaria. The meeting shared innovative approaches, technologies, and interventions that have contributed to advancing malaria control and elimination efforts in some countries, and discuss strategies to address disparities in malaria burden and access to services, with a focus on vulnerable populations/regions. In addition, the meeting discussed the awareness among stakeholders regarding the critical need for sustained investment and dedication to malaria control and elimination initiatives.
A challenging context
In 2022, approximately 166 million malaria cases and 423,000 malaria deaths occurred mostly in 12 countries. Africa contributed to 11 of the countries (Burkina Faso, Cameroon, Democratic Republic of The Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda, and the United Republic of Tanzania) while Asia had one country, India. Collectively, these 12 countries were responsible for over 70% of global malaria incidence and 73% of global malaria mortality.
Africa continues to face the harsh reality of malaria. According to the World Health Organization, 94% of all malaria deaths are in Africa. Data for 2022 show that 608,000 lives were lost and 249 million new cases occurred in Africa.
In March 2024, the African leaders committed significantly through the Yaoundé Declaration on Malaria. This declaration is a testament to a collective determination to intensify efforts to combat malaria and significantly reduce malaria-related deaths. It emphasizes the importance of the “High Burden High Impact” (HBHI) approach, focusing on four key pillars: political will, strategic use of information for action, better technical guidance, and coordination. Additionally, the declaration underscores the significance of functional national health systems and the adoption of a multi-sectoral approach to sustainably address malaria across the continent.
Malaria is still a big problem worldwide, and we’re not on schedule to end it as a threat by 2030. It’s crucial to step up our efforts, protect the progress already made and beat this disease.
Dr Maru Aregawi from WHO Afro highlighted that The Global Fund aims to reduce malaria mortality by 90% by 2030, with milestones of 40% by 2020 and 75% by 2025. These targets are yet to be achieved.
The fight against malaria is not without its challenges. While there has been success in eliminating malaria in 11 countries outside Africa and reducing endemic regions from 93 in 2015 to 84, Africa’s burden is still high. Key issues include complex epidemiology, weak health systems, poverty, resistance to insecticides and medicines, and disruptions of health service delivery due to conflicts.
The Role of the African Constituency Bureau (ACB) in Combatting Malaria
Malaria continues to be a formidable public health challenge across Africa, and the role of African constituencies in the Global Fund is vital in combatting this disease. With strategic planning, active engagement, and collaborative efforts, the ACB brings together the two constituencies to work towards eradicating malaria, improving health outcomes, and addressing the multifaceted challenges that hinder progress.
Also called The Bureau, ACB is essential in bringing together the two African constituencies and supporting the committees and the board to advance the malaria discussions. Their focus is on reviewing and strategizing to ensure progress in disease eradication. Among other things, we advocate collaboration towards effective primary care, quality labs, and strengthening health systems is central to the agenda, aiming to empower the African continent.
Key priorities include:
- Shaping policies for disease prevention
- Enhancing local manufacturing of health products
- Ensuring grant performance
- Addressing the impacts of climate change
- Maintaining quality assurance policies
The Zambian Experience
In Zambia, malaria is endemic. The disease is a significant health issue, accounting for over 30% of the disease burden. It is one of the leading causes of mortality in the country. Key interventions that the country has embarked on include:
- Vector Control: Distributing long-lasting insecticidal nets (LLINs) through antenatal care (ANC) and mass campaigns, indoor residual spraying, and larval source management.
- Case Management: Ensuring all suspected malaria cases are diagnosed and treated with over 95% diagnostic coverage.
- Community Health Access: Expanding integrated community case management, achieving over 90% coverage.
- Parasite Control: Conducting mass drug administration and reactive case investigations.
- Health Promotion: Engaging communities and advocacy efforts.
In addition, Zambia has used surveillance systems that integrate high-quality data and emerging tools to use other sources, such as climate and entomological data, for early warning systems. Decentralization has been part of the intervention by emphasizing community-level decision-making and ownership. End Malaria Council, domestic and donor support, with additional support from religious and private channels, have also helped to finance the interventions. Despite the concerted efforts, Zambia recorded a 5% increase in malaria cases, from 8.1 million in 2022 to about 11.1 million, reflecting a broader continental trend of rising malaria incidence.
The case of Ghana
Addressing malaria elimination poses a significant challenge in synchronizing country-specific priorities with those of donor entities. This predicament is aptly illustrated in the case of Ghana, where the national strategy for eliminating malaria revolves around vector control, particularly Indoor Residual Spraying (IRS) and Larvae Source Management. The Global Fund has been a staunch advocate for bed nets over IRS and LSM, citing the high cost associated with the latter.
In response to this discordance, Ghana strategically presented a compelling business case for the continuous implementation of IRS, underscoring the ineffectiveness of bed net utilization in certain regions, notably due to high temperatures in the northern part of the country. The country collaborated with the Country Coordinating Mechanism (CCM), and conducted a national prioritization exercise to champion the need for IRS. This concerted effort led to a consensus where the IRS was approved for a one-year implementation period, followed by operational research to validate its efficacy over the subsequent two years.
Partnerships played a pivotal role in this endeavor, with the government, The Global Fund (TGF), and the CCM actively collaborating to align priorities and strategies. Key takeaways from this experience included the importance of data-driven decision-making, fostering country ownership, mobilizing key and vulnerable populations, and building consensus among stakeholders to align development partners with national goals.
Moving forward, the recommendations emerging from Ghana’s experience highlight the critical need for countries to establish robust institutions, empower communities, and leverage dialogue to advance national agendas. Donor entities are encouraged to support home-grown solutions tailored to the specific needs of beneficiary countries. Furthermore, enhancing effective partnerships and local capacities is paramount to realising country-led and country-ownership principles espoused by initiatives such as the Global Fund.
Ghana’s journey in navigating the complexities of balancing country-specific and donor priorities in malaria elimination programs offers valuable insights for policymakers and practitioners globally. By embracing data-driven decisions, promoting country ownership, and fostering partnerships grounded in local solutions, countries can effectively advance their malaria elimination agendas while aligning with the diverse priorities of development partners.
Financial Investments and Challenges
Significant investments by the Global Fund since 2018, amounting to over $50 million, have targeted combating malaria by addressing resistant mosquitoes and benefiting children under five. Efforts include:
– Testing and treatment grants emphasizing timely healthcare
– Increasing trained health workers for education and outreach
– Expanding malaria vaccine implementation
Despite progress, challenges persist due to the impact that COVID-19 has had on service delivery, drug and insecticide resistance, climate change, and limited healthcare access. Malaria cases and deaths have risen in high-burden countries, obstructing global reduction targets by 2025. Increasing investments, innovative disease surveillance, strengthening health systems, promoting equity, and fulfilling commitments from high-level meetings such as the Yaoundé Declaration are critical steps forward.
The Way Forward
Commitments from African ministers, underscored by the Yaoundé Declaration, emphasize reducing malaria mortality, leveraging community health workers, and improving surveillance and infrastructure. Mapping mortality drivers, engaging stakeholders, and integrating accountability frameworks are essential strategies.
Conclusion
The fight against malaria in Africa requires sustained efforts, innovative solutions, and robust commitments from all stakeholders. By empowering African constituencies, enhancing collaborative efforts, and focusing on strategic interventions, there is hope for significant progress towards malaria eradication by 2030. Zambia’s and Ghana’s experiences exemplify the challenges and successes in this critical battle, underscoring the need for continued vigilance and proactive measures.
Armelle Nyobe
