Initiatives to Eliminate Malaria
The Pan American Health Organization (PAHO) and World Health Organization (WHO) have initiatives in place to help eradicate malaria with hopes that malaria will be eliminated by 2030. Five initiatives to eliminate malaria are Municipalities for Zero Malaria, Malaria Champions of the Americas, Global Technical Strategy for Malaria, Millennium Development Goal 6, Rapid Access Expansion Program (RAcE) and the Global Malaria Program. It is estimated that half the world’s population, 108 million, is at risk for malaria.

Municipalities for Zero Malaria

Municipalities for Zero Malaria is a newly launched initiative by PAHO arriving on World Malaria Day, April 25, 2019. This initiative is focused on the Americas and its struggles and triumphs with malaria. Recent research has found that malaria in 19 countries exists in 25 municipalities. These 25 municipalities hold 50 percent of all cases of malaria in the Americas. This new initiative will focus on the empowerment of communities and addressing malaria at a local level. Local level measures allow for earlier access to diagnosis and treatment for malaria patients as well as raising awareness of seeking health care treatment. According to Dr. Marcos Espinal, the goals and keys for the success of the Municipalities for Zero Malaria are that “Organizations, citizens and local government authorities must be engaged in developing key interventions for malaria elimination at a municipality level if we are to ensure that no one gets left behind.” This initiative will be a part of the current program, Malaria Champions of Americas.

Malaria Champions of the Americas

Malaria Champions of the Americas started in 2009 and honors countries that have the best practices for eliminating malaria. This organization is a platform to continue to promote good news about malaria and the ongoing fight to eliminate it. The organization chooses and nominates municipalities based on efforts to eliminate malaria. This year, Malaria Champions of the Americas hopes that the new initiative, Municipalities for Zero Malaria, will spark new growth at local level prevention and eradication of malaria. Over the past 11 years, these great initiatives made an effort to eliminate malaria:

  1. In 2010, Suriname achieved a 90 percent decrease in the incidence of malaria through its National Malaria Board initiatives.
  2. Paraguay became champions in 2012 because of its efforts to control malaria on national, regional and local levels. Its National Malaria Eradication Service of the Ministry of Public Health and Welfare opened up 20 labs for diagnosis and seven entomology labs.
  3. Costa Rica accomplished a 100 percent decrease in malaria from 2000 until 2014 due to its national plan to eliminate malaria and supervised malaria treatment programs.
  4. Suriname decreased its malaria-related hospital admissions from 377 in 2003 to 11 in 2015. In addition, these hospitals had no death records for 2014 and 2015.
  5. El Salvador accomplished a decrease of 98 percent of malaria cases in 2014.
  6. Brazil’s National Program for the Prevention and Control of Malaria was about to treat 97 percent of patients within 24 hours after diagnosis of malaria in 2014.
  7. In 2017, Brazil became champions again after the number of malaria cases dropped from 8,000 in 2013 to 126 cases in October 2017. Brazil also reduced malaria in isolated populations.
  8. Paraguay received the WHO certification of a malaria-free country in 2017.

World Health Organization

The World Health Organization has three initiatives currently in motion. WHO’s Global Malaria Program is an overarching program that guides all of WHO’s initiatives and publishes a yearly malaria world report. As of 2017, incidence rates have dropped from “72 to 58 per 1000 population at risk” and deaths declined from 607,000 in 2010 to 435,000 in 2017. Currently, 46 countries have equal to or less than 10,000 cases of malaria.

The Global Technical Strategy for Malaria is a longterm initiative that will run from 2016 until 2030. The goal is to reduce case incidence and mortality rates by 90 percent, eliminate malaria in more than 35 countries and prevent the revitalization of malaria in areas it no longer exists. The program is primarily to help guide and support regional programs with the elimination and prevention of malaria.

Rapid Access Expansion Program (RAcE) concentrates on five endemic countries, Democratic Republic of Congo, Malawi, Mozambique, Niger and Nigeria, through an integrated community case management (iCCM) program. Each country has a corresponding organization partner to help obtain the goals of RAcE. The objectives of RAcE are to reduce the mortality rates, increase the access to diagnosis, treatment and referral services, meet the Millennium Development Goal 6 and provide evidence and support to WHO policymakers on iCCM. RAcE’s results have been successful with “over 8.2 million children under 5 were diagnosed and treated for malaria, pneumonia, and diarrhea from 2013-2017.” The program also trained 8,420 health care workers to deliver these services to communities.

The Millennium Development Goal 6 has achieved its goal with a 37 percent decrease in cases of malaria over 15 years. Estimates determine that malaria-ridden countries avoided about 6.2 million deaths between 2000 and 2015 due to the initiatives to eliminate malaria.

– Logan Derbes
Photo: Flickr

WHO's Rapid Access Expansion ProgramThe World Health Organization (WHO) created the Rapid Access Expansion Program (RAcE) in 2012 to prevent children’s deaths in remote areas of Africa. RAcE trains health workers to care for children suffering from malaria, pneumonia, diarrhea and malnutrition. This program is necessary, as it is estimated that one-third of the 2.9 million children who died in Africa in 2015 could have survived if they had access to healthcare.

RAcE integrates the diagnosis, treatment and referral of children who initially present with a fever. Research shows that this system increases rates of necessary treatments for malaria and catches diseases that may also present with a fever, such as pneumonia and diarrhea. These three diseases are curable if diagnosed and treated early enough. This style of treatment is also more cost-effective.

The program is implemented in a five-year plan and is currently expanding in five countries: the Democratic Republic of the Congo, Malawi, Mozambique, Niger and Nigeria. RAcE works with the governments of these countries to train health care workers and create evaluation systems in remote areas. These countries have many rural villages whose occupants cannot easily access a health center.

Community health workers get trained and live in the community where they work. These areas are often rural and difficult to access. The community health workers become a valuable resource for people in the village who might not have access to healthcare otherwise. The volunteers are trained to diagnose malaria with a rapid test and treat children with as artemisinin-based combination therapy. Health workers treat diarrhea with oral rehydration salts and zinc. If health professionals recognize the signs of pneumonia, they treat it with amoxicillin.

So far, RAcE has produced promising results. Over six million correct diagnoses of malaria, pneumonia and diarrhea have been recorded. The under-five mortality rate in has dropped 53 percent globally since 2000. Nearly 8,400 community health workers are trained to work in integrated treatment for children. Some countries have altered their national health policies to use rapid diagnostic tests for malaria and amoxicillin in community health care practices.

Perhaps most importantly, the Rapid Access Expansion Program has provided information on how to scale up an integrated treatment system. RAcE depends on many organizations to provide training, supplies and monitoring systems. Each of these organizations researched the best way to train workers and set up their facility.

For example, the program in Malawi studied several variants to understand how the program could be expanded to a national level. Nongovernmental organizations or governments that want to attempt integrated community healthcare can learn from these studies. The Democratic Republic of the Congo and Nigeria plan to expand their programs based on the evaluations from RAcE.

Sarah Denning

Photo: Flickr