Tiaan de Jager and Taneshka Kruger
Malaria is a preventable and treatable disease that continues to pose a major public health threat, particularly in places with high transmission such as the Southern African Development Community (SADC) region.
As we observe SADC Malaria Day on 6 November, it is important to recognise that eliminating malaria is an achievable goal, but it is one that can be realised only through sustained collaboration, strong partnerships, funding and good leadership.
The World Health Organisation (WHO) African Region bears the largest malaria burden worldwide. In 2022, the region accounted for 94% of all malaria cases (233 million) and 95% of all malaria deaths (580 000). About 78% of these deaths were among children under five years of age. While significant progress has been made in the fight against malaria, eliminating the disease remains a major challenge. Since 2015, progress against cases and deaths has stalled in several countries; this was worsened, especially in sub-Saharan Africa, by disruptions caused by the Covid-19 pandemic and other humanitarian emergencies.
Malaria is endemic to 14 of the 16 SADC countries, with at least three-quarters of the region’s population living in malaria-risk areas. Risk varies widely within and between the countries, with rural and impoverished communities bearing the brunt of the effects of the disease.
Four SADC countries continue to report very high transmission rates and account for about a quarter of the global malaria burden: the Democratic Republic of the Congo (12.3%), Mozambique (4.2%) Angola (3.4%) and the United Republic of Tanzania (3.2%).
The region is characterised by fluid and interconnected borders with high cross-border movement, which complicates efforts to control the spread of infectious diseases. Migrants, cross-border traders and nomadic populations often carry malaria parasites from high-transmission areas to low-transmission zones, reintroducing the disease in areas that have seen progress.
SADC countries like Botswana, Eswatini and South Africa have made tremendous progress towards malaria elimination and, according to the WHO, each has the potential to eliminate it by 2025. These nations have shown that it is possible to bring malaria to the brink of elimination through effective partnerships and strategies, including concerted cross-border efforts to prevent a resurgence of the disease.
Mauritius has eliminated malaria altogether and is preventing the reintroduction of the disease.
On 18 August 2018, the SADC heads of states committed to achieving a malaria-free region by 2030 when they signed the Windhoek Declaration on Eliminating Malaria in the SADC Region. No country can achieve elimination alone. The theme for SADC Malaria Day this year – ‘Strengthening Regional Cooperation to Eliminate Malaria’ – highlights the crucial role that collective action plays in the fight against malaria, especially across borders.
Since its launch in 1998, the Roll Back Malaria (RBM) Partnership to End Malaria has played a pivotal role in uniting governments, international organisations, private sector entities and civil society in the fight against the disease. As the global framework for action, the RBM focuses on reducing malaria cases and deaths, working in tandem with national programmes to achieve the broader goal of malaria elimination.
One of the RBM’s key achievements has been fostering partnerships that address both technical challenges and resource mobilisation, ensuring that malaria interventions are sustainably funded and accessible to affected communities.
A strong partnership exists between SADC and the RBM, which has been vital in strengthening regional approaches to malaria control and elimination. Malaria does not respect national borders – formal or informal – and in a region where mobility is high, cross-border transmission remains a major challenge.
Through the SADC Malaria Elimination Framework, the RBM has provided technical and strategic support to align the malaria plans of SADC countries with the broader goal of regional elimination. In addition, it has supported SADC countries to launch the Zero Malaria Starts with Me campaign, a community-driven initiative that seeks to mobilise political commitment and raise awareness about malaria prevention.
Apart from technical interventions, regional collaboration fosters political commitment. When countries work together, they can secure more significant funding and political will to sustain malaria control efforts. The latter is particularly important in maintaining progress towards elimination, as countries must remain vigilant to avoid a resurgence once malaria transmission has been reduced.
The University of Pretoria Institute for Sustainable Malaria Control strongly believes in building partnerships and collaboration to help Africa become malaria-free. The institute recently signed a memorandum of understanding with the RBM that detailed shared objectives such as capacity building; student support; resource mobilisation; addressing challenges such as climate change impact and cross-border collaboration; strengthening partnerships in South Africa; and establishing an academic and research working group.
Dr Douglas Mombeshora – Zimbabwe’s Minister of Health and Child Care, and Chair of the SADC Health Committee – praised the memorandum of understanding as a milestone, noting its support for local medical practitioners who are tackling malaria. He stressed the government’s role in leading malaria elimination through strong, impactful leadership.
Leadership at both national and regional levels is crucial to the success of malaria elimination efforts in SADC regions. Countries that have made the most progress in reducing transmission have shown strong political commitment, backed by well-organised national malaria control programmes. Initiatives to build capacity in leadership is strongly supported by the SADC heads of state.
Along with partner support and funding from the Bill & Melinda Gates Foundation, the University of Pretoria Institute for Sustainable Malaria Control developed and presents a leadership capacity-building course, which highlights that cross-border coordination allows countries to work together on surveillance, prevention and treatment strategies. Sharing data and resources is essential to identifying transmission hotspots and deploying interventions where they are most needed.
By strengthening leadership at all levels, from policymakers to programme managers, countries will be more able to sustain the efforts needed to achieve malaria elimination.
For more information about malaria and the UP ISMC, visit www.malaria.up.ac.za
Professor Tiaan de Jaager is the Director: UP ISMC, Dean: Faculty of Health Sciences and Professor: Environmental Health. Dr Taneshka Kruger is the Senior Project Coordinator: UP ISMC at the University of Pretoria.