Tuesday, August 23, 2016

Is a malaria free Africa by 2030 possible?

By Esther Nakkazi
Is a malaria free Africa by 2030 possible? The glass is half full.

Forty-seven World Health Organisation member states in the African Region unanimously adopted a new malaria framework with specific actions to reach ‘an African Region free of malaria’ by 2030.

In a meeting held in Addis Ababa on 21st August, they came up with a framework to guide member countries towards attaining targets of the Global Technical Strategy (GTS) for malaria (2016-2030) within a given time frame.

The GTS was founded in May 2015 at the 68th World Health Assembly on the vision of a world free of malaria and consists of four goals and related targets to be achieved by 2020, 2025 and ultimately by 2030.

It for instance aims to reduce malaria mortality rates and case incidence by at least 90% by 2030 as well to eliminate malaria from at least 20 malaria endemic countries. It also aims to prevent re-establishment of malaria in all Member States that are malaria-free.

A press release from WHO AFRO says this framework's priority interventions and actions have been organized according to programme epidemiological strata in order to engender evidence-based targeted interventions.

The GTS has guiding principles like country ownership and leadership with involvement and participation of communities within a multisectoral context. It also encourages mobilizing and working with other sectors in malaria control and elimination.

To an extent some of these goals are achievable.  Some projects have demonstrated it. Six countries; Algeria, Botswana, Cape Verde, Comoros, South Africa, Swaziland have the potential according to the WHO to eliminate local transmission of malaria by 2020.

Meanwhile, two countries, the Democratic Republic of the Congo (DRC) and Nigeria alone account for more than 35% of the global estimated malaria deaths so if efforts are concentrated here that would give a lot of mileage I suppose.

But how possible is it that the Africa region can be malaria free by 2030?

Well, there is some impressive progress so far in controlling it. Since 2000, malaria death rates have plunged by 66%, translating into 6.2 million lives saved, most of them children. Between 2000 and 2015, the number of malaria cases and deaths within the African Region declined by 42% and 66%, respectively says the WHO.

In addition, more people with suspected malaria get tested before treatment and many more are sleeping under insecticide-treated mosquito nets. In 2014, 65% of the suspected malaria cases got tested before treatment compared to only 41% in 2010. In 2015, two in three households in Africa had their own insecticide-treated mosquito net, compared to only 2% back in 2000.

And like Dr Matshidiso Moeti, the WHO Regional Director for Africa said, “Malaria is no longer the leading cause of death among children in sub-Saharan Africa. More and more children get to sleep under a net.”

Malaria is also still on top of the global and regional agenda and so it remains a priority, identified in target 3.3 of the Sustainable Development Goals (SDGs) which commits to end it by 2030. The WHO also reaffirms to end it by then.

However, despite the significant progress made, malaria continues to be a major health and development problem in the Africa Region as it still bears the biggest malaria burden with about 190 million cases (89% of the global total) and 400 000 deaths (91% of the global total) in 2015 alone.

We cannot talk about a malaria free Africa without talking funding which the World Malaria report 2005 says increased substantially by 410% between 2005 and 2013 for programme financing. Overall, international financing for malaria control increased from US$ 100 million to US$ 1,640 million in 2013.

But the report also shows that even with these increases the annual investment per person at risk remained low at US$ 2 in the year 2013 and this funding situation is further threatened by low domestic financing.

So in the period 2005-2013, the proportion of total malaria funding contributed by national governments in Africa stagnated at less than 10% and these rely on external funding.

Meanwhile, based on GTS cost estimates and at a fixed 2013 population at risk of malaria in Africa of about 830 million, the total cost of malaria elimination in Africa by 2030 is US$ 66 billion.

There is thus a funding gap which is not new because most health projects are suffering from low aid.

Furthermore, implementation of the GTS will necessitate addressing some key challenges like weak health systems (which were tested during the Ebola outbreak).

As well there is the threat of resistance to the medicines combined to a lack of a vaccine and the adverse effects of climate variability and change.

One of the reasons for reversing the malaria deaths as mentioned earlier was as said by Dr Moeti; ‘more children slept under a net but there is need to continue to invest in changing people’s behaviours.’ She also said more people with suspected malaria got tested before treatment.

It is only if people in the region change their behaviour and sleep under treated nets and also seek treatment within 24 hours after testing. These are some of the sustainable ways to keep the gains achieved and also move forward.

Otherwise, the glass really remains half full as the balance for the gains and the challenges for implementing the GTS remains glaringly odd.

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