What malaria-free Sri Lanka can teach us

It has been more than three years since Sri Lanka has seen a case of Malaria. In these three years, millions of lives have been saved. Sri Lanka’s journey in fighting Malaria has not been a linear one – the disease was almost eradicated in the 1940s but when funding decreased and political instability increased the progress made was reversed. It has taken many years to eradicate the last hundreds of cases. A multi-pronged intervention strategy targeting both the mosquito and the parasite that causes the disease has been part of a broader successful effort at eradicating the disease. Other interventions included

Clinics, indoor spraying, bed nets, rapid diagnostic kits and a combination of medicines. Together these interventions resulted in success – Sri Lanka was declared malaria-free by the World Health Organisation (WHO) in September this year. This is a significant victory for healthcare.

By the end of the decade, many more countries have the potential to become malaria-free, using the example of Sri Lanka and Malaysia to target interventions to the context. As we noted in September, the WHO estimates that malaria deaths have fallen by 60% since 2000 and an estimated 663 million cases have been prevented. Yet, more than 400 000 people died of malaria in 2015, and 90% of these were in Africa, and most of them were under the age of five. In addition, the DRC and Nigeria account for 40% of all malarial deaths, with many African countries having high prevalence.

So how can South Africa and other African countries learn from Sri Lanka’s examples?

The strategies employed in Sri Lanka included:

  • Treating people as soon as possible to kill the parasite in their blood stream, preventing further transmission;
  • Setting up mobile malaria clinics in high transmission areas to provide better and more rapid access to treatment, and to medical check-ups;
  • Regular surveillance of the disease and the progress in treating it;
  • Ensuring that public awareness raising and education was conducted to make sure that people could self-identify risks and symptoms;
  • Dedicated and targeted funding from the Government; and
  • Mosquito control efforts such as nets and sprays.

The Sri Lankan example highlights the need to use resources effectively. Mobile clinics could provide a meaningful solution in Africa where access to health varies dramatically depending on geography and economic circumstances.

South Africa’s own strategies include:

  • Passive, active and entomological surveillance;
  • Monitoring and evaluation and malaria information systems at all levels;
  • Integration with other government stakeholders and partners for implementing key interventions and cross-border malaria initiatives; and
  • Building capacity in skills and numbers for malaria elimination.

All of this requires budget and commitment. Positively, on the list of 21 countries that could eliminate malaria within the next four years, six are African including Algeria, Botswana, Cape Verde, Comoros, South Africa, and Swaziland. The end of the decade is not far away, and the remaining years will need to see a commitment to maintaining the gains that have been made, and to addressing the areas where gaps continue to occur. JPS Africa is working to focus on both prevention and treatment to ensure that the potential to eliminate malaria is met and that it endures.




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