A surge in cases in 2016 prompted WHO to announce that progress against the disease had stalled. More resources must be invested in the fight, leaders and experts say. Elsewhere, community health workers recruited in their own remote communities have seen great success

Zimbabwe was honoured on January 28th for leading the way to a Malaria Free-Africa. The country received the honour from the African Leaders Malaria Alliance (Alma) at the 30th African Union (AU) Summit, Zimbabwe’s The Herald reported. Alma members are drawn from 49 AU countries with the objective of eradicating malaria on the continent by 2030.

At the 2018 Alma Awards for Excellence, presented by UN Secretary-General Antonio Guterres and new AU Chairman and Rwandan President Paul Kagame, Zimbabwe, Madagascar, Senegal and the Gambia were honoured for reducing malaria cases by more than 20% from 2015 to 2016. Algeria and Comoros were awarded for being on track to achieving an over 40% drop in cases by 2020.

While malaria deaths have plunged by over 60% since 2000, cases rose in a majority of African countries in 2016. The World Health Organisation (WHO)’s World Malaria Report 2017 signalled that, for the first time in more than a decade, progress against malaria on the African continent has stalled. The treatable and preventable disease already costs the continent’s economy $12bn per year in direct losses, and 1.3% of lost annual GDP growth.

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Since Miriam completed her training as a local community health worker, no children have died in the village. Photo: WHO

The AU has always advocated that it is critical to sustain the political commitment, as articulated in its Agenda 2063, which seeks to eliminate malaria in Africa by 2030 through increased domestic financing, increased access to life-saving interventions, and more robust health systems.

Some 90% of all malaria cases still occur in Africa. Swaziland Prime Minister Dr Barnabas Sibusiso Dlamini said it was important that African countries allocate budgets to eliminate malaria.

“When we take our eyes off malaria, the cost for our countries is huge. Yet if we increase our efforts to control and eventually eliminate malaria, the yield we get from it is tremendous,” he said.

To continue to win the war, considerably more resources will need to be invested in the fight, agreed  Executive Secretary of Alma, Joy Phumaphi. “It is a fight that can be won,” she stressed.

In 2018, Alma will support the Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH) scorecards in 19 countries and those related to malaria will be rolled out in 10 African countries.

On the positive side, more people at risk of malaria in Africa (54%) are sleeping under an insecticide-treated net, indicating some success in behaviour change and outreach campaigns.

Nigeria has seen success with integrated community case management (iCCM), a cost-effective strategy that engages community health workers living in hard-to-reach areas to diagnose and treat malaria, pneumonia and diarrhoea.

Through WHO, the Canadian government has funded a five-year grant to bring iCCM to remote communities in sub-Saharan Africa countries with a high disease burden, WHO reported on its website.

In the three years since Etsu Gudu’s health worker Miriam was selected and completed training, no children have died in the village, and no children have been referred to the faraway hospital. She says, “as a mother and as a woman, I feel very happy and other married women feel happy. I enjoy the work.”

Key elements of effective iCCM implementation are recruitment of educated workers who live within remote communities, training and regular supervision, sustained supply of quality medicines, and community support and engagement. The programme is unique in that it involves both the community and the health system.

An external evaluation from 2017 provides evidence that RAcE contributed to reducing child deaths in Niger and Abia States, and the Ministry of Health plans to extend iCCM to other states as part of its strategy to provide health coverage.

In areas like Etsu Gudu, the pleasures of rural life and close-knit communal living are balanced by subsistence-level incomes and limited, difficult access to health facilities. Arranging for a single sick child visit could mean missing one or more days of work, as well as costing up to one third of the family’s monthly income. (Sources: The Herald  1/2; WHO 1/2; Alma 2/1)

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Find out more in the Africa Research Bulletin:

HEALTH: Malaria
Political, Social and Cultural series
Vol. 54, Issue 4, pp. 21416A–21417C

New WHO director
Political, Social and Cultural series
Vol. 54, Issue 7, p. 21524C

HEALTH: AIDS Conference
Political, Social and Cultural series
Vol. 54, Issue 12, pp. 21704A–21704C

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