Part II: The Global Strategy
1. Introduction to the Global Strategy
Malaria occurs in 109 countries around the world. A strategy combating malaria should be both country-led and internationally supported. Individual countries are often best positioned to know which actions are most appropriate depending on the populations at risk, the level of transmission, the degree to which interventions are in place, and the capacity of countries’ health systems to take these efforts further. The international community, on the other hand, plays a critical role by supporting countries and providing tools. Through cooperation, countries and international partners can achieve the near-term goals of mortality and morbidity reduction by 2010 and 2015 as well as the longer-term vision of worldwide eradication.
Three Components of the Global Strategy: Control, Elimination and Research
The Global Strategy consists of three components (Figure II.1) that will ensure these ambitious goals can be achieved: 1) Controlling malaria, 2) Eliminating malaria and 3) Research into new tools and approaches.
Figure II.1: Three components of the global strategy
- Control. The majority of malaria-endemic countries can make a substantial impact on their malaria burden by controlling it with existing tools. By first scaling up appropriate interventions for all populations at risk and then sustaining control over time, malaria will cease to be a major source of deaths world-wide.
- Elimination. Reducing to zero all locally-acquired infections within a country will bring the world closer to the ambitious goal of global eradication. Some countries are currently engaging in elimination and more will transition to elimination after achieving control provided there is strong rationale for this move. In high transmission settings, complete interruption of malaria transmission will require additional, new control tools.Global malaria control and elimination: report of a technical review. Geneva, World Health Organization, 2008.
Click for source
- Research. Malaria control and elimination efforts will require continued research to be successful. International research is needed to create new tools, as well as inform policy and improve operational implementation of strategies. Then, national and local health systems must focus on how to use the tools and sustain the gains.
Targeted Efforts for Big Impact
All countries are an important part of the global strategy and will contribute to the success of the world-wide objectives against malaria. However, in a resource constrained environment, global resources may not be sufficient to support all countries at the same time. To achieve the 2010 and 2015 global targets, scale-up efforts in at least the highest burden countries are essential.
As illustrated in Figure II.2, countries can be grouped into the following categories:
- High contribution to global deaths in the control stage. 35 countries are responsible for the majority of the total deaths world-wide. The 5 main contributors (Nigeria, Democratic Republic of Congo, Uganda, Ethiopia and Tanzania) amount to 50% of global deaths and 47% of cases. Many of these 35 countries have high transmission of P. falciparum malaria and are located in sub-Saharan Africa; others have very large populations at risk, especially in Southeast Asia.
- Low contribution to global deaths. 74 countries bear a lower share of the malaria burden. There are two main groups, depending on the objective of their current national anti-malaria program.
- Low contribution in the control stage: Forty-seven countries bear a smaller share of the global deaths and cases attributable to malaria. They have malaria control as their current objective. Most of these countries have low to moderate transmission of P. falciparum, mixed transmission, or P. vivax transmission only. They are mainly located in South America, in Africa or in Asia-Pacific. A few countries (e.g. Haiti, Dominican Republic, Timor-Leste) have high transmission but, because of their small size, contribute little to the global death toll.
- Low contribution in the elimination stage: Twenty-seven countries have very low burden levels and are currently in various stages of the elimination process as reported by WHO. As more countries transition out of the control stage and into the elimination stage, greater international emphasis will be placed on elimination. They are mainly located in the Eastern Mediterranean region, in North Africa, in the Americas or in the Western Pacific region.
I.2: Country categorization by malaria control status and burden
Source: World Malaria Report 2008. Geneva, World Health Organization, 2008; 2006 data
The Global Strategy chapters that follow will describe how countries and global players can work together on control, elimination and research to fight malaria. The final chapter highlights the costs and financial considerations to implement the control and elimination strategies within countries, to conduct the R&D needed for control and elimination tools, and the health systems research required for scale-up, sustained control and elimination strategies. It concludes by illustrating the economic and epidemiological benefits of malaria control.