Regional collaborations
Elimination 8
The Elimination 8 (E8) is a regional initiative that brings the four southern-most countries in Africa together with their northern neighbors to eliminate malaria. The E8 was established in 2009 through a coordinated effort among the MEI, the Minister of Health and Social Services of Namibia, the Roll Back Malaria Partnership, the World Health Organization, the Southern African Development Community (SADC), and the eight participating country partners. Today, the E8 has been endorsed as a SADC regional initiative that directly contributes to the goal of a malaria-free southern Africa. The E8 aims to accelerate progress towards elimination by creating an enabling environment for the achievement of national elimination goals. This is done by providing a platform for information sharing and joint strategic planning, as well as supporting coordination and implementation of “supra-national” activities that go beyond the scope of an individual country’s elimination program. The E8’s Secretariat is based in Windhoek, Namibia. The MEI has provided foundational, technical and operational support to the E8 since 2009.
Across the eight E8 countries, malaria cases have decreased by about 35% over the past five years. A few countries in southern Africa are leading the way in elimination: Swaziland is aiming for national elimination by 2017, South Africa and Botswana by 2018, and Namibia by 2020. Mozambique, Zambia, and Zimbabwe have set subnational elimination goals in the next few years, and Angola is considering the potential for subnational elimination in its southern provinces.
African Leaders Malaria Alliance
The African Leaders Malaria Alliance (ALMA) is a coalition of 49 Heads of State and Government working across national and regional borders. Established in 2009, ALMA leverages its collective knowledge and influence to bring about action and accountability by providing a forum to review progress and challenges to malaria control and elimination, implementing monitoring and accountability systems, and identifying and sharing lessons learned across country programs. Motivated by the progress already seen on the continent, the African Union called for action towards malaria elimination by 2030. To this end, the Chair of ALMA launched the ALMA 2030 Africa Malaria Elimination Scorecard, which allows countries to track progress and hold themselves accountable for reaching elimination targets.
Working together
The collaboration between E8 and ALMA allows the region to have a comprehensive approach to elimination. While the E8’s Ministerial Committee addresses some of the technical and policy issues around eliminating malaria in southern Africa, ALMA serves as a key partner for elevating the malaria-elimination agenda at the highest political levels, informing decision-making on issues such as domestic investments for malaria, and bilateral/trilateral government collaboration. Since 2014, ALMA has also provided key support to E8 through the development of an accountability mechanism, the “E8 Malaria Elimination Scorecard,” which provides a snapshot of how E8 countries are performing relative to each other and to regional elimination targets.
Challenges to elimination
Population mobility
Population movement in southern Africa is often made up of different categories of migrants, including workers, family members, international students, asylum seekers, refugees, other displaced persons, and victims of human trafficking. High rates of mobility and migration across the region lead to continued and increased cross-border malaria transmission. Mobile populations, particularly those that are undocumented, often face complex obstacles in accessing essential health care and malaria-control services. Many of them fear deportation if they seek malaria treatment while crossing a border. This, in turn, increases their susceptibility to malaria-related morbidity and mortality due to delays in detection and treatment, and it can lead to reintroduction of malaria in areas that have eliminated. The MEI has an innovative program of research to help national malaria programs identify and support mobile populations.
Surveillance
Because of high rates of malaria importation from one southern African county to the next, regional surveillance becomes a critical issue for countries striving to eliminate the disease. Southern African countries currently operate with independent surveillance systems, each with its own unique indicators, and there is very limited data sharing across countries. Many of these countries maintain weak information management systems and lack the capability to actively respond to cases. The E8 is working to develop a harmonized surveillance system across the region, which will be critical to catalyzing and guiding response efforts and limiting the level of cross-border malaria transmission.
