Published: 29 November 2022

By Professor Sheila Tlou and Anthony Okara, ALMA Special Ambassadors

Malaria remains a significant health challenge in Africa with countries in the continent accounting for 96% of global malaria cases and 98% of global malaria deaths. In the Southern African Development Community (SADC) where approximately 83% of the population live in malaria risk areas, the disease continues to impact livelihoods affecting education, labour and employment, stalling economic growth and development. The COVID-19 pandemic and the impact of the ongoing crisis in Ukraine, further compounded this unfavorable impact, with disruptions in access to malaria services, increased costs contributing to the reversal in progress made in Member States.

In 2021, SADC Member States reported 63,685,376 million malaria cases and 42,871 deaths. More than 80% of the cases were reported in four Member States, including the Democratic Republic of Congo (39%), Mozambique (16%), Angola (14%) and Malawi (11%). More than 84% of the deaths were reported from two member states, Democratic Republic of Congo accounting for half of these, and a third from Angola. Malaria also accounted for 17% of out-patient attendances, and one in ten deaths and about 5% of all hospital admissions.

Today, the fight to end against malaria in SADC faces a new threat – the challenge of 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. While commemorating the annual SADC Malaria Week in Kinshasa Congo (7th – 11th November 2022), SADC Member States called for increased domestic investment to boost the malaria fight and support national malaria programmes cope with the impact of the COVID-19 pandemic.

SADC’s call for increased domestic investments sets the region on the path to sustainability. However, to obtain value from the domestic resources raised, there’s a further need for countries in the region to develop stronger accountability frameworks that are tailored to the specific context and needs of each country.

Member States are deliberate and intentional about harnessing and exploiting the domestic funds to achieve the health goals. Led by Zambia, Eswatini and Mozambique, the SADC region has set the pace in establishing multi-sectoral national End Malaria Councils and Funds. These mechanisms have increased multi-sectoral engagement, advocacy, accountability and resource mobilisation, with millions of dollars raised to support national malaria programmes.

To date, six countries in Africa have established End Malaria Councils and Funds to keep malaria high on the financing and domestic agenda, with another 20 countries in the planning stages. These Councils and Funds have mobilised millions of United States Dollars in financial and in-kind support for the fight against malaria. The creation of the End Malaria Councils and Funds remains a priority agenda of His Excellency President Umaro Sissoco Embaló, the Chair of African Leaders Malaria Alliance (ALMA). President Embaló’s priority agenda also includes strengthening engagement with Regional Economic Communities to address key challenges and provide solutions in the fight against malaria. A continental ‘Malaria Youth Corps’ that mobilises thousands of existing youth leaders across the African continent to champion youth engagement and resource commitments for malaria elimination has been activated, while digitalisation and real time data remains an anchor in supporting evidence informed decision making.

Given that malaria-transmitting mosquitoes know no borders and with significant population movements within the SADC region, there is a further need to bolster regional cooperation and multisectoral collaboration in this fight. ALMA continues to strengthen engagement with SADC and other Regional Economic Communities in Africa to keep malaria high on the regional political, development and financing agenda. To date all blocs have signed Memoranda of understanding with ALMA and the RBM Partnership to End Malaria with clear Plans of Action to coordinate the malaria response in Member States. This regional cooperation has resulted in a significant reduction of malaria witnessed in the cross-border initiative involving the Kingdom of Eswatini, the Republic of Mozambique and the Republic of South Africa (the MOSASWA initiative) thereby opening avenues for investment and economic growth in that part of the continent. Similar success stories have been reported in the Namibia and Angola border areas (Trans-Kunene Malaria Initiative), as part of the Elimination 8 initiative. Member States have embarked on developing a roadmap to mainstream malaria elimination in the non-E8 countries.

In 2018 the SADC Heads of States and Governments signed the Windhoek Declaration to End Malaria, thereby reaffirming their commitment to the elimination of the disease in accordance with the SADC protocol on health and the malaria elimination framework. This has paved way for a number of activities aimed at protecting SADC’s hard-won gains and regain traction in our fight against malaria in the region. However, the setback in the acceleration of the path to elimination caused by the COVID-19 pandemic has resulted in the loss of some gains and momentum that countries had built towards malaria elimination.

While funding remains critical, the need to invest in new approaches and innovations and improve use of existing tools can not be understated. If we do not increase investment in fighting malaria, we will not achieve our continental goals to end the disease as a public health threat by 2030. Now more than ever, it is clear that malaria is a pathfinder for pandemic preparedness and response, including through support to community health workers who identify and report on fever cases, and ensure prompt and effective treatment. Eventually, we are assured of a healthier, more equitable world.