The Elimination 8 was created in 2007 by eight African countries with an initiative of abolishing malaria in Africa by 2030. By 2020, the E8 hopes to terminate malaria in the four low transmission countries of Botswana, Namibia, South Africa and Swaziland. By 2030, the E8 aims to terminate malaria in the four middle to high transmission countries of Angola, Mozambique, Zambia and Zimbabwe.

The E8 created a strategic plan to focus on strengthening efforts at cross-border and regional levels. The five core objectives of the plan are:

E8’s Five Core Objectives

  1. Strengthen regional coordination in order to achieve elimination in each of the E8 member countries. While countries continue to pursue their own malaria elimination efforts, the E8 serves as a platform of communication and guidance between countries to advance regional-level efforts. The E8 coordinates a regional structure for all countries to follow in an attempt to stop malaria from spreading across borders. It also partners with the E8 scorecard, which actively monitors the malaria statistics and progress of the countries’ efforts on an annual basis.
  2. Elevate and maintain the regional elimination agenda at the highest political levels within the E8 countries. The E8 relies on partnering with several organizations in order to continue shrinking malaria in Africa. The Ministers of Health and their partners act as additional leadership for malaria elimination. Through ALMA and SARN, the E8 has the ability to publish the E8 scorecard, which is crucial in holding countries accountable for their malaria efforts. Senior political officials help raise awareness for the E8 and can help to secure financial partners.
  3. Promote knowledge management, quality control and policy harmonization to accelerate progress towards elimination. Africa experiences heavy population movement throughout its countries that contribute to the spread of malaria. The E8 created regional maps that outline statistics such as the risk of transmission across borders and human mobility patterns. The main goal is to uncover the “sources and sinks of malaria,” or the areas that export malaria to other countries and the areas that receive malaria from outside sources.
  4. Facilitate the reduction of cross-border malaria transmission. The E8 countries are expected to follow a minimum set of standards in their efforts of shrinking malaria in Africa including the use of insecticides, insecticide resistance and management planning and case classification. The E8 provides guidance through managing information and relaying it across countries.
  5. Secure resources to support the regional elimination plan, and ensure long term sustainable financing for the region’s elimination ambitions. In order for the initiative to succeed in shrinking malaria in Africa, the E8 requires substantial funding. The E8 has decided on a resource mobilization strategy that attempts to fund regional activities from long-term partners. Although this strategy does not fund individual country initiatives, the E8 provides intelligence to support each country.

The Back-and-Forth

The E8 countries experienced a 50 percent decrease in malaria cases over a five year period, from 14 million cases in 2007 to eight million cases in 2012. One particular country, Swaziland, experienced a drastic decline in malaria cases. In 2010-11, Swaziland reported 478 malaria cases during the transmission season with only three malaria-related deaths.

However, in the 2016-2017 malaria season, seven out of the eight countries reported an increase in malaria cases with outbreaks reported in Botswana and Namibia. Through the E8, health ministries held a meeting to determine the source of the alarming rates.

Two main factors were found in the cause of the increase. First, mosquitos were becoming resistant to insecticides and countries were not meeting their spraying targets; and second, insufficient use of surveillance systems caused late responses and a lack of epidemic identification.

Hope for the Future

In spite of the increase of malaria rates, the E8 is continuing to better their efforts to continue shrinking malaria in Africa. “I’m still optimistic and looking at 2025-2030,” says Richard Nchabi Kamwi, former Namibian Health Minister and now the E8 Ambassador for Malaria Elimination.

“Swaziland, for example, is far ahead– for the past five years it did not record a single malaria death. Botswana unfortunately during the last season experienced some local deaths, but I was impressed with the aggressive way in which they responded to the epidemic and how they persevered with their plan. Now it’s 2017, so maybe eradication by 2020 will not happen, but I am looking at 2025, with the final four countries following suit by 2030.”

The countries have modified their action plans for the next malaria season and have prepared epidemic response plans — hopeful omens for the future.

– Anne-Marie Maher

Photo: Flickr