Challenges to elimination
Imported cases
Much of Sri Lanka remains both receptive and vulnerable to malaria transmission, and the number of imported malaria cases has increased in recent years, which highlights the potential impact of importation on the risk of reintroducing the disease. The majority of imported cases originate in India, but recent clusters of imported infections have been detected among Pakistani asylum-seekers and Sri Lankan fishermen returning from Sierra Leone. Robust surveillance, border screening, prompt diagnosis and treatment, and thorough case investigation and follow-up are essential activities in the AMC’s current plan to prevent reintroduction of malaria.
Sustaining political and financial investment
In order to maintain elimination, Sri Lanka must sustain adequate levels of resources and attention for malaria surveillance and response. As the country nears its fourth year of zero local cases and celebrates its recent WHO malaria-free certification, political pressure to reallocate resources to competing public health threats, such as dengue fever, puts malaria prevention efforts at risk. The MEI’s recent collaborations with the AMC on an investment case for malaria revealed a 13:1 return on investment, underscoring the great value for resources dedicated to the prevention of reintroduction of malaria. As Sri Lanka’s history demonstrates, the risk of malaria’s resurgence is real if political and financial support decreases. Increasing domestic financing for malaria, particularly as the country anticipates future transition from external donor funding, will be critical to sustain elimination in Sri Lanka. To this end, the MEI is supporting the AMC to carry out strategic, targeted advocacy to ensure that malaria financing is adequately met and sustained at sub-national and national levels.