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With a 64% reduction in malaria cases since 2010, AsiaPacific has made impressive progress towards malaria elimination. Much of thissuccess is due to regular and ongoing efforts to survey, test, treat, andmonitor malaria cases. As a communicable disease, malaria is apt to resurge ifthese efforts lose momentum. This is a concern for countries that have nearlyeliminated the disease and even for countries like Sri Lanka and China whichhave been declared malaria-free.
Until malaria is eliminated everywhere, resurgence remains adeadly threat. That is why national malaria programmes as well as institutionslike the Global Fund see sustainability as a core component to ensure long-termsuccess against this disease. Research from the Global Fund and the Universityof California San Fransisco’s Malaria Elimination Initiative have identifiedfive key domains of sustainability:
APLMA partnered with the Malaria Elimination Initiative todevelop a Thematic Feature on sustainable malaria financing in Asia Pacific.This Thematic Feature looked at six country cases to share examples and bestpractices on how to implement activities and programmes across allsustainability domains.
Leadership and Management
From 30 million malaria cases annually in the 1940s to beingcertified malaria-free in 2021, China’s success in eliminating malariastems from strong and sustained political commitment. Strong high-levelleadership helped ensure malaria elimination laws, policies, and budgetallocations were made and sustained at national and local levels tosuccessfully eliminate this deadly disease. In Vietnam, many leaders inmalaria-free provinces show continued commitment to maintaining theirmalaria-free status.
Integration
Three years after successfully achieving malariaelimination, China continues to utilize a strong whole-of-governmentapproach to ensure their malaria programme is integrated within the healthsystem and beyond. Over a dozen different Ministries and departments continueworking together to track imported malaria cases and prevent re-establishmentof malaria. The Philippines have also made strong progress towardsestablishing Universal Health Coverage to integrate malaria and many otherhealth challenges into the health system for improved efficiency and patientcare. In Vietnam, some district-level malaria programmes have alreadybegun integrating malaria services with other communicable diseases likedengue.
Health Workforce for Malaria
Even after successfully eliminating malaria in 2016, SriLanka continues to ensure knowledge of malaria remains strong among thehealth workforce. Malaria is still featured in undergraduate medicalcoursework, and Anti-Malaria Campaign personnel regularly give talks and raiseawareness of malaria efforts for practicing clinicians and field staff acrossthe country. In Thailand, an estimated 48% of remaining vertical malariaprogramme staff nearing retirement age provided the impetus to strengthenalready ongoing efforts to integrate, train and empower health services inmalaria elimination efforts. In Cambodia, the government is working tostrengthen internal human resource capacity after realizing an over-reliance oncivil society implementors could risk long-term sustainability in malariaefforts.
Health Product Management
Despite having eliminated malaria years ago, Sri Lankamaintains a strong supply chain for malaria medicines and diagnostic tools. Guidelinesare in place to ensure commodities like intravenous artesunate, an importanttreatment for malaria, are made available in any part of the country within twohours of a request.
Financing
In Thailand, the Division of Vector Borne Diseaseshas engaged with Local Administrative Organizations (LAOs), the subnationalgovernmental units of Thailand, to secure domestic funding for malaria-relatedactivities through LAO budgets. The Philippines have also developedmultiple streams of domestic financing for malaria, including through a SpecialHealth Fund, earmarked funds in national and local government budgets, and eventhrough their reformed tax law on tobacco and alcohol products. By comparison, Cambodia still receives90% of all malaria financing from external donors including the Global Fund. Toensure successful and sustained malaria elimination efforts, Cambodia is in theprocess of undergoing a landscape assessment to quantify future financingrequirements and potential domestic and international funding sources.
Many countries in Asia Pacific are at the last mile ofmalaria elimination. The dual challenge of eliminating malaria at the last mileand preventing malaria re-establishment requires ongoing programmatic effort. Asuccessful transition to a sustainable malaria programme requires activeadvance planning and continued efforts to embed malaria elimination as part ofa whole-of-government approach. Learn more about best practices andrecommendations for a sustainable transition in this Sustainability Thematic Feature.
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