15 October 2013
Shawn Clackett

Time to eliminate malaria in southern Africa

As published in the Business Day Wednesday, 9 October 2013.

Malaria continues to be a drain on our people and our economies but, with adequate resources and commitment, we can imagine a malaria-free southern Africa, write Richard Feachem and Yvonne Chaka Chaka

Richard Feachem

Richard G A Feachem is Director of the Global Health Group at UCSF Global Health Sciences

Yvonne-Chaka-Chaka

Yvonne Chaka Chaka is a South African singer and Roll Back Malaria Partnership Goodwill Ambassador

One of the largest gatherings of the malaria community, the Multilateral Initiative on Malaria, takes place in Durban this week. This year’s theme, Moving towards malaria elimination: Investing in research and control, calls for stakeholders to take stock of the gains made in the global fight against malaria and to commit to a goal that many believed unreachable a decade ago: a malaria-free southern Africa.

Success in the fight against malaria has been remarkable over the past decade: malaria deaths fell 33% in Africa and 21% worldwide between 2000 and 2011. Southern Africa, in particular, has seen dramatic progress. South Africa, for instance, has cut malaria cases 85% between 2000 and 2011, thanks to steady malaria control in the three malarious regions of Limpopo, Lubombo and Mpumalanga. Today, much of South Africa is malaria-free and the country aims to eliminate it by 2018. Similarly, Swaziland has achieved a 98% decrease in reported cases from 2000-2011 and is on track to eliminate malaria by 2015, which would make it the first country to eliminate malaria in mainland sub-Saharan Africa — a historic achievement.

But maintaining momentum depends on overcoming a number of important challenges, including insufficient funding to finish the job. With the major external source of funding for malaria, the Global Fund to Fight AIDS, TB and Malaria, changing its funding model to prioritise applications from low-income and high-burden countries, countries in southern Africa are vulnerable to a decrease in support for their activities. This could undo years of work and millions of dollars of investment and, worse, it could allow a resurgence of malaria. Given this risk, governments must step up and commit resources to get the job done.

One opportunity for additional support lies with South Africa. As the leading economy in the region, South Africa can make an important contribution by supporting malaria control efforts in neighbouring countries where the malaria burden is higher, as a way of protecting itself from imported cases. In 2010, at least 70% of the malaria cases in Mpumalanga were imported from other countries. Preventing malaria at home will also reduce the number of South Africans exporting malaria.

As malaria knows no borders, regional initiatives that encourage collaboration between countries can help address the challenge of malaria importation. For example, the Elimination 8 is a regional initiative that supports the goal of malaria elimination in the eight southernmost African countries. Chaired by Namibian Health Minister Richard Kamwi, it encourages cross-border initiatives between countries, such as the Lubombo Spatial Development Initiative between Mozambique, South Africa and Swaziland, and the Trans-Kunene Malaria Initiative between Angola and Namibia. The malaria control programmes of these countries support each other’s malaria efforts by harmonising interventions, such as use of insecticides or malaria testing in border regions. But these partnerships are challenging to implement. Lack of funding to support cross-border projects, as well as political and administrative hurdles, can hamper success. Additional support from governments across southern Africa is needed to facilitate these partnerships.

While governments are strengthening national and regional efforts to eliminate malaria, researchers and implementers are rising to other challenges, developing innovative solutions, tools and technologies to eliminate malaria.

The progress of the past decade is impressive but fragile. We know from experience that once malaria is eliminated or driven to low levels, if efforts wane, it can be easily reintroduced. With the unstable economic situation of many donors, external support is at risk. The governments of southern Africa must renew their political and financial commitment to malaria elimination, and to essential regional collaborations.

Southern African leaders and governments need to act now and commit to malaria elimination — and to dedicate national resources to the goal. Malaria continues to be a drain on our people and our economies. But with adequate resources and commitment, we can imagine a day when we will be able to drive from Cape Town to Dar es Salaam through a completely malaria-free southern Africa.

404
Pacific Friends operates as a program within the Kirby Institute at the University of New South Wales.

Pacific Friends

Professor Janice Reid AC
Chair
Bill Bowtell AO
Executive Director

Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.

Funders

Partners

Social Media