Framework for implementing the Global Technical Strategy for Malaria 2016–2030 in the African region: report of the Secretariat

Abstract

1. Malaria control in the WHO African Region has recorded progress, with a 42% reduction in case incidence and a 66% decline in the mortality rate between 2000 and 2015. This is the result of the expanded use of cost-effective prevention and case management services. However, malaria remains a regional and global priority as reflected in the Sustainable Development Goals and the Global Technical Strategy (‎GTS)‎ for malaria (‎2016–2030)‎ adopted by the World Health Assembly (‎WHA)‎ in May 2015. The vision of the GTS is “a world free of malaria”. It has four goals and related targets to be achieved by 2030. The GTS interventions consist of three pillars and two supporting elements. The pillars are: (‎a)‎ ensure universal access to malaria prevention, diagnosis and treatment; (‎b)‎ accelerate efforts towards elimination and attainment of malaria-free status; and (‎c)‎ transform malaria surveillance into a core intervention. The supporting elements are: (‎a)‎ harnessing innovation and expanding research; and (‎b)‎ strengthening the enabling environment. 2. Several challenges still hamper efforts towards malaria control and elimination in the Region. These include weak health systems, gaps in uptake of available interventions, low per capita investment on malaria, and the threat of resistance to medicines and insecticides. 3. This framework was developed to support implementation of the GTS in the African Region. Its vision is “an African Region free of malaria”. Its objectives are: (‎a)‎ to reduce malaria mortality rates by at least 90% by 2030 compared with 2015; (‎b)‎ to reduce malaria case incidence by at least 90% by 2030 compared with 2015; (‎c)‎ to eliminate malaria from at least 20 malaria endemic countries; and (‎d)‎ to prevent re-establishment of malaria in all Member States that are malaria-free. The aim of the framework is therefore to provide guidance to Member States and partners on regionspecific priority actions towards attaining the goals, targets and milestones of the GTS. 4. The framework proposes specific priority interventions and actions to be implemented by Member States. Countries and districts are stratified into four phases based on the parasite prevalence or the Annual Parasite Index (‎API)‎. In phase 1, programmes are in control mode and are characterized by more than 5% parasite prevalence or API of five or more per 1000 population. Phase 2 encompasses pre-elimination programmes and is characterized by parasite prevalence of less than 5% in all ages, or API of 2–4 per 1000 population, with focalized and seasonal transmission. In phase 3, elimination programmes are characterized by API of 1 or less per 1000 population. Phase 4 programmes aim at preventing re-establishment of local malaria transmission: they are characterized by three consecutive years of zero malaria cases or include countries that have already been certified as malaria free by WHO or classified as malaria free in the 2015 baseline classification or those that have been naturally malaria free. 5. The Regional Committee examined and adopted the priority interventions and actions proposed in this Framework.