In Southern Africa, the malaria season typically begins with the summer rains in November and ends in April. In this region, the co-ordination of malaria control efforts between neighbouring states has dramatically reduced the incidence of malaria. For instance, the three-country control programme, jointly implemented and managed by Mozambique, South Africa and Swaziland, has reduced the incidence of malaria on the border between South Africa and Mozambique from about 25% in 1998 to less than 2% in 2001. Similarly, in both Swaziland and South Africa, malaria cases and deaths have declined to a record low.
The four frontline countries on the tip of Africa (Botswana, Namibia, South Africa and Swaziland) are surging forward in their work towards malaria elimination. For this to become a reality, the frontline countries depend on four neighbouring countries (Angola, Mozambique, Zambia and Zimbabwe), to up their malaria control efforts. Over the past decade, South Africa, in particular, has made strong progress.
Malaria morbidity and mortality in South Africa decreased 89% and 85% respectively from 2000-12, from 64,500 malaria cases to 6,847, and from 460 deaths to 70. This is a big achievement and means South Africa has now reached one of the Millennium Development Goals (to halt and begin to reverse the incidence of malaria) set by the United Nations General Assembly in 2000.
SADC countries maintain evidence-based and comprehensive malaria control programmes. Among the antimalaria interventions, the most successful to date has been indoor residual spraying, which involves the application of small amounts of insecticides approved by the WHO to the inside walls of houses. Insecticide spraying does not pose a threat to human health or the environment. It is a tried and tested way of saving lives and protecting residents. Additionally, all Sadc countries have implemented improvements to treatment regimens, providing easier access to safe and effective malaria medicines.
To keep malaria at bay and to secure a malaria-free future, continued investment from donor nations and malarial countries, and the development of new strategies and technologies such as new effective insecticides, are essential. History shows that any decrease in support of the fight against malaria leads to a resurgence of the disease, potentially undoing years of effort and investment.
The WHO's Dr Margaret Chan says, "The past five years have seen an impressive increase in international funding for malaria prevention, control and elimination. In the past decade, an estimated 1.1-million malaria deaths were averted, primarily as a result of a scale-up of malaria interventions. But the available funding still falls short of the resources required. An estimated $5.1bn is needed every year from 2011 to 2020 to achieve universal access to malaria interventions."
Countries in Southern Africa have demonstrated a strong political commitment towards malaria elimination. But while commitment is necessary, it is not sufficient. Even technical interventions, such as spraying, have demonstrated that dramatic successes can be achieved in terms of lowering the incidence of disease, but still are not enough.
Countries that have eradicated malaria, succeeded by matching solid public health interventions with policies that foster growth and prosperity. Sadly, most African countries remain mired in poverty and most people can barely afford to sustain themselves, let alone improve their homesteads and pay prevention costs and medical fees when disease strikes.
The SADC countries' health ministers need to refer to past successes, for example, and then determine to lower the burden of disease by drafting, not only co-ordinated national policies aimed at eliminating malaria, but ones that will also help their countries and their people to grow richer. Only when we eliminate dire poverty, will it be possible for this disease to be eradicated once and for all.
Urbach is director of Africa Fighting Malaria.