Roll Back Malaria Progress & Impact Series:
Focus on South Africa
Progress and impact of malaria control in South Africa at a glance
South Africa has been able to roll out and sustain effective malaria control interventions for more than 70 years, largely through domestic funding. After a major epidemic in 1999/2000, the country implemented evidence-based and practical policies that have successfully positioned it to eliminate the disease by 2018.
The country has a decentralized malaria control programme, with the national malaria programme at the National Department of Health (NDOH) defining policies and guidelines, and providing technical support to provinces. Activities occur at a provincial level, funded by a dedicated budget through the national treasury. Elimination interventions are focused on cross-border collaborations with Mozambique, Swaziland and Zimbabwe, integrated vector management, robust health promotion activities and a solid active surveillance programme.
The national budget for malaria control increased significantly between 2007 and 2008, reaching an average of US$ 25 million annually between 2009 and 2012.
South Africa enforced malaria control strategies and implemented critical interventions:
- Indoor residual spraying (IRS) coverage of targeted structures was 88% on average in malaria-endemic provinces between 2000 and 2012, with about 1.8 million structures sprayed in 2012/2013.
- Rapid diagnostic tests (RDTs) were rolled out nationwide in 2003 and artemisinin-based combination therapies (ACTs) introduced for uncomplicated case management subsequent to parasitologically confirmed diagnosis in KwaZulu-Natal in 2001, in Limpopo in 2004, and in Mpumalanga in 2006.
- Since 2000, all suspected malaria cases have been diagnosed using microscopy and/or RDTs. In 2011, 61% and 39% of malaria cases were respectively confirmed by microscopy and RDT.
- All positive cases are treated within 24 hours, and treatment is only prescribed once cases are confirmed (not presumptively).
- Training is a cornerstone of the malaria control programme: more than 7700 spray operators were trained between 2005 and 2012; an average of 500 doctors and nurses are trained each year in managing severe malaria; and regular training sessions in malaria case management are organized for health-care workers.
- South Africa was instrumental in initiating cross-border malaria initiatives, such as the Lubombo Spatial Development Initiative (LSDI) through the signing of a trilateral agreement with heads of state in Mozambique and Swaziland. These efforts led to further reductions in malaria morbidity and mortality in South Africa.
Added to continued socioeconomic improvements in South Africa, the roll-out of malaria control interventions and strategies allowed the following disease burden reductions:
- Nationwide, malaria morbidity and mortality decreased 89% and 85% respectively between 2000 and 2012, from 64 500 to 6847 malaria cases, and from 460 to 70 deaths.
- Between 2011 and 2012, local and imported cases decreased by 18% and 24% respectively. In 2012, 69% of reported malaria cases were imported, and all districts nationwide had less than 1 local malaria case per 1000 population at risk, advancing South Africa another step towards eliminating the disease.
- Cross-border collaborations had a remarkable impact in KwaZulu-Natal and Mpumalanga where malaria cases dropped by 93% (from about 54 400 to 3900) in the two provinces taken together between 1999/2000 and 2010/2011.
- According to estimates based on the 2000 malaria outbreaks in KwaZulu-Natal, at least 165 000 malaria cases are averted each year in the three endemic provinces through effective malaria control activities.
The main lesson learned from more than 70 years of malaria control efforts in South Africa is that the country has been using indoor residual spraying to decrease the disease burden and effective antimalarial drugs over time, adapting its policies based on appropriate surveillance data.
South Africa has developed a malaria elimination plan, with the goal to end local transmission by 2018. It is hoped the country will close the funding gap already identified, so that it can strengthen its human resource capacity, improve its evidence-based research for surveillance and response, and ultimately realise its malariafree goal.