Collaborating towards a malaria-free Southern Africa: A look at the region’s milestones and achievements

Time to deliver zero malaria – Invest, innovate, implement – Racing towards malaria elimination in Africa by 2030

Africa continues to bear the highest malaria burden. According to the WHO’s World Malaria Report 2022, 96% of all malaria cases (238 million cases) and 98% of all malaria deaths (603,877 deaths) occurred in Africa in 2021. Children under the age of five are particularly vulnerable, with 77% of malaria deaths reported in this age group. In sub-Saharan Africa, 17% of deaths in children under five are due to malaria, compared to 8% globally.

The impact of malaria on the Southern African Development Community (SADC) is significant, with approximately 83% of the population living in malaria risk areas; thereby affecting livelihoods, education and employment, and stalling economic growth and development. SADC member states in 2021 reported 63 million malaria cases and 42 871 deaths. More than 80% of the cases were reported in four member states: the Democratic Republic of Congo (39%), Mozambique (16%), Angola (14%) and Malawi (11%). Malaria also accounted for 17% of out-patient attendances, and one in 10 deaths and about 5% of all hospital admissions.

Despite the high burden of malaria in the region, countries in Southern Africa have made notable progress in reducing malaria cases and deaths over the past decade by implementing interventions such as increased use of insecticide-treated nets and indoor residual spraying, improved diagnostic testing and effective treatment with antimalarial medications. However, the fight against malaria in SADC today faces a new threat — the challenge of the sustainability of malaria programmes — as several member states are transitioning out of eligibility for funding from the Global Fund due to a change in their income classification. This calls for increased domestic investment to boost the malaria fight. 

To achieve zero malaria, there is an urgent need for action and further investment in the fight against malaria. This year’s World Malaria Day theme, “Time to Deliver Zero Malaria: Invest, Innovate, Implement,” underscores the need to expand current interventions and recognise the research community’s contributions while urging further investment in transformative tools. The burden of malaria undermines Africa’s collective social and economic development and is a barrier to achieving the objectives of the Agenda 2063, “The Africa We Want”. But progress is achievable when there is strong political will, country ownership, strong partnership, adequate resources and a shared sense of urgency.

Significant investments are still required to increase coverage of key interventions

To achieve the ambitious goal of eliminating malaria by 2030, it is crucial to make significant investments in expanding the coverage of key interventions. The global pledge of $15.7 billion made in 2022 to replenish the Global Fund fell short of the target of $18 billion. This shortfall, coupled with the ongoing economic challenges of high inflation and increased costs of delivering commodities to end users, means that many countries are facing significant funding gaps in their malaria programming. 

The majority of countries in the Southern Africa region are experiencing the threat of insecticide resistance and need to introduce next-generation nets and insecticides, and expand investment in surveillance. While these new strategies — as demonstrated by Malawi and Mozambique’s use of dual insecticide nets, which led to a decrease in malaria cases by more than 40% where they were deployed — have proven to be highly effective, they come at an increased cost. Globally, we must also invest in research and development of new products in collaboration with academic institutions and the private sector, and shape the market for next-generation commodities to help reduce prices and ensure production volumes can meet demand.

To make progress in the fight against malaria, countries must have adequate resources to deploy tailored, locally appropriate, and life-saving interventions on a large scale, based on malaria transmission settings. As such, mobilising additional resources, including from domestic public and private sectors, is imperative for getting back on track towards ending malaria.

His Excellency President Umaro Sissoco Embaló of the Republic of Guinea-Bissau and Chair of ECOWAS, upon assuming chairmanship of the African Leaders Malaria Alliance (ALMA), outlined a four-point priority agenda aimed at accelerating progress and ending malaria’s heavy health burden in Africa by 2030. The agenda focuses on multisectoral advocacy, action and resource mobilisation; harnessing data for accountability and action through the use of scorecard tools; engaging a continental youth corps; and enhancing regional and cross-border coordination in the fight against malaria, with sustained political commitment, continued investment, and collaboration across sectors and borders.

Multisectoral advocacy and resource mobilisation 

End Malaria Councils & Funds (EMC/Fs) have emerged as a key mechanism for driving domestic and sustained investment in national malaria programmes. EMC/Fs are country-owned and country-led mechanisms comprising senior leaders from government, the private sector, civil society, and communities to mobilise multisectoral advocacy, action, resources and accountability for the fight against malaria. Currently, 12 African Union (AU) member states have launched or announced EMC/Fs, with another 13 in progress, and several have integrated EMCs into their national strategies as the primary mechanism for mobilising multisectoral advocacy, action and resources.

As EMC/Fs expand across the continent, several have made significant strides in the fight against malaria. For example, in Eswatini, the End Malaria Fund received pledges worth $600 000 at its’ launch in 2019 and has mobilised more resources in cash and in kind in subsequent years. The council has supported the development of a national transition and sustainability plan with the Global Fund, procured antimalarials, supported the distribution of insecticide-treated mosquito nets and Indoor Residual Spraying, and launched the Eswatini Malaria Youth Army to strengthen efforts to eliminate malaria in the country. More recently, the Fund has engaged a South African pharmaceutical manufacturer to open a packaging plant in Eswatini. This partnership will see the Fund receive an offtake to provide a sustainable source of funding (tax free). Similarly, Mozambique’s Fundo da Malaria has convened a parliamentary forum on malaria, to ensure that malaria elimination remains a national priority. In Zambia, the End Malaria Council helped to mobilise a $6 million commitment from the Rotarian Malaria Partners to support community health workers and launched a partnership with the Zambia Football Association to support social and behavioural change communications.

During the 2022 Kigali Summit on Malaria & NTDs, the chairs from EMCs in Eswatini, Zambia, Mozambique, and Kenya announced a joint pledge to mobilise $100 million to support their countries’ national malaria programmes. In addition, several EMCs are actively working to mobilise additional resources to support universal net campaigns scheduled for 2023. South Africa has also announced plans to establish its own End Malaria and NTD council in 2023. Through these initiatives, the EMCs in the region are making significant strides towards ending malaria in their respective countries.

Harnessing data for accountability and action

Access to high-quality and timely data is crucial for effective decision-making and action in malaria control and elimination. Improving data quality and availability through initiatives such as malaria repositories and subnational stratification, and using data to drive action and accountability using tools such as scorecards, enables policymakers, health administrators, and partners to systematically identify and respond to operational bottlenecks and upsurges.

The ALMA Scorecard for Accountability & Action, Regional Scorecards, National Scorecards and Community Scorecards continue to drive action, including enhanced resource commitments, addressing emergencies and upsurges, facilitating commodity procurement and intervention deployment, and enhancing the availability and quality of data.

Countries across Southern Africa have adopted national malaria control and elimination scorecards, enhancing their response to national accountability mechanisms. For example, in Eswatini, the scorecard helped flag a stockout of malaria medication due to long delivery times associated with the Covid-19 pandemic. To resolve this, Eswatini worked with its multisectoral End Malaria Fund to mobilise resources to procure replacement stocks, increasing the number of severe cases receiving treatment from 67% in 2021 to 100% in 2022.

In Zambia, while malaria is still a major public health challenge and remains endemic across all 10 provinces, the country has made steady progress in the fight against the disease. This is attributed to increased efforts by the Zambian government and partners, as well as the use of innovative tools such as the malaria scorecard management tool. The scorecard tool is connected with Zambia’s Health Management Information System (DHIS2) and is used by the National Malaria Elimination Programme and partners to monitor progress against 11 key malaria indicators at both national and sub-national levels, including provinces and districts, to drive action.  

Zambia’s use of the national malaria scorecard to generate and track actions through existing accountability and coordination mechanisms at both national and subnational levels led to the country receiving the Best Malaria Scorecard Tool award at the inaugural ALMA Joyce Kafanabo Awards during the AU Summit held in Addis Ababa, Ethiopia in February 2023. Additionally, the Southern African Development Community (SADC) and other Regional Economic Communities (RECs) have been supporting the implementation of the regional Elimination 8 (E8) scorecard to achieve a malaria-free Southern Africa.

Malaria does not recognize borders, so member states are working across them

Malaria and its vectors do not respect national borders, and with increasing cross-border movement across the continent, effective malaria control and elimination requires coordinated efforts at regional and continental levels. The African Union (AU) has mandated Regional Economic Communities (RECs) to develop strategies and plans for more effective coordination of malaria control and elimination at the regional level. The Southern African Development Community (SADC) produces a comprehensive report on the status and barriers to malaria control and elimination across Southern Africa annually, which is presented during the SADC Ministers Meeting. Coordination by SADC and the E8 Secretariat continues to help harmonise policies on malaria elimination and has contributed towards progress on joint monitoring of these policies. SADC continues to have multisectoral advocacy during its malaria week each November as a means of highlighting the malaria season and key areas for action in Southern Africa.

AU member states are increasingly realising the significance of cross-border collaboration and are working with their neighbouring countries to coordinate malaria interventions and planning. For instance, Eswatini, Mozambique and South Africa have jointly implemented cross-border interventions through MOSASWA/LSDI2, with funding from the three countries, the Global Fund, the Bill and Melinda Gates Foundation and additional funding from South Africa and the private funding via Goodbye Malaria for interventions in Southern Mozambique. These collaborative efforts showcase the potential of cross-border partnerships to amplify the impact of malaria interventions and make significant strides towards eliminating the disease from the continent.

Member states are recruiting youth to champion the fight against malaria

Youth are an important constituency under the African Union’s development agenda. African youth account for 60% of the population, representing the largest segment of the population. Their passion, innovation, and creativity have vast potential to contribute significantly to the fight against malaria. At the direction of the ALMA Chair, member states are establishing national campaigns to engage youth as the next generation of malaria leaders.

Southern African countries Zambia, Eswatini and Mozambique have established Malaria Youth Corps to drive advocacy for the prioritisation of malaria as a matter of national concern. In 2022, through the implementation of the ALMA Youth Strategy, these young people proved themselves to be critical stakeholders for advocacy, action, and resource mobilisation in the fight against malaria. They participated in high-level meetings and implemented innovative anti-malaria activities, including community action and sensitisation. For example, youth from Zambia organised community events for World Malaria Day and World Mosquito Day to sensitise communities to malaria prevention. 

Malaria is a clear pathfinder for pandemic preparedness and response

Investing in the eradication of malaria can generate a high return on investment. As research shows, every $1 invested can yield an estimated economic return of $26. By reducing malaria transmission, we can improve health outcomes, increase productivity and reduce healthcare costs, thereby contributing to economic growth. Investing in malaria elimination not only saves lives but also has a significant positive impact on the economy. Moreover, investing in measures such as community health workers and enhanced disease surveillance can improve the capacity and resilience of our health systems to respond to future pandemics and epidemics. By strengthening countries’ capacities to combat malaria, we can enhance broader pandemic preparedness and response.

The Covid-19 pandemic and other disease outbreaks such as Ebola have heightened awareness and political will to address health crises. The global community is actively working to strengthen health systems, prepare for future outbreaks, and address existing health threats such as malaria, HIV/AIDS, TB, and NTDs. Malaria is uniquely positioned as a pathfinder for pandemic preparedness and response, and despite the challenges posed by Covid-19, countries have made significant efforts to sustain malaria interventions and ensure access to essential malaria services.

As such, further strengthening investment in malaria prevention, diagnostic testing and treatment can strengthen health systems, including expanding community health worker programmes, enhancing digital tools for disease surveillance and detection, sharing real-time data, and increasing the capacity of national laboratories. Local manufacturing can also play a crucial role in enhancing regional resilience and growth in Africa, promoting the affordability, accessibility, and long-term sustainability of health commodities, as well as supporting regional economic development. As other parts of the continent gain momentum in promoting local production of health commodities, Southern Africa can learn from its continental counterparts to further catalyse its own efforts toward malaria elimination.

Zero malaria in Africa requires continued investment, innovation, and implementation

As the battle against malaria continues in Southern Africa, a tireless effort by governments, organisations and communities is underway to combat this deadly disease. The expansion of End Malaria Councils and Funds in the region holds the promise of significant strides towards multisectoral advocacy and resource mobilisation, while collaborative efforts championed by Regional Economic Communities and member states testify to the power of cross-border cooperation in the fight against malaria. National malaria control and elimination scorecards have been adopted in Southern African countries, further enabling greater accountability and progress towards malaria elimination objectives. Additionally, initiatives to promote local manufacturing of malaria commodities in Africa aim to ensure affordability, accessibility and long-term sustainability of life-saving commodities. Involving young people in these initiatives emphasises the importance of engaging the next generation in the fight against malaria. Although challenges persist, the time has come to achieve zero malaria in Africa, and this will require continued investment, innovation, and implementation. The progress achieved in the region provides hope that the global goal of eliminating malaria by 2030 can be accomplished through ongoing collaboration, innovation and investment.