Kampala  – Over the past two decades, the world has made great progress in reducing malaria cases and deaths, but the pace has stalled in many high malaria burden African countries. Global malaria cases dropped by 29% between 2000 and 2019, but only by 2% between 2015 and 2019 when deaths fell by 15% compared with 60% between 2000 and 2019. Professor Francis Omaswa, Executive Director, African Centre for Global Health and Social Transformation, explains what needs to be done to get malaria control and prevention back on track.   

Why do we need to rethink malaria prevention?

There are two major reasons why we need to rethink malaria in Africa. First, is the fact that performance indicators have stagnated and are getting worse in some areas. Second, is that health systems are transitioning from top-down leadership to community ownership with generation and application of local solutions by the affected communities. We are off the track towards malaria elimination due to governance issues. Less money is going into malaria prevention programmes. The burden of malaria is not seen as a priority by political leaders and even the population themselves. There is a slackening of effort despite data indicating that we are stagnating. The new direction for malaria control is to stop the top-down response and embark on an integrated, people-centred primary health care systems. This is the foundation of health systems of the future not only for malaria control but to achieve universal health care and reach the Sustainable Development Goals.

Why has the progress against malaria slowed down?

The root cause of the slowdown is the loss of political commitment and the assumption that malaria control is already being taken care of under global health initiatives such as the Global Fund and other donors. Secondly, the collaboration between malaria control programme managers who produce data and decision-makers who allocate resources must be stronger. It is not enough to just generate statistics. What has not worked is the link between needs of the population, malaria researchers and political decision-makers. That triangle has collapsed. Malaria is a persistent socio-economic and development challenge that cannot be solved by malaria technical experts working alone. There is need for a new generation of actors across all sectors and society using the whole society approach.

What is the implication of this slowdown?

We cannot accept that children die of malaria, that pregnant women get complications and die due to malaria. Accepting the intolerable is what has happened. This must change. We cannot accept preventable deaths. We must ensure that the affected people are participating in the efforts to improve their lives and well-being. That is the crucial role that a people-centred health care system plays. Community health systems ought to be empowered to cause action. Until that happens things will continue to go the wrong way.

We have a new opportunity to rethink malaria, make a new beginning and learn from past failures.

How can we get back on track to meet the malaria-reduction targets?

To get back on track we need to open dialogue with all stake holders especially communities and political leaders. We must also bring evidence on the table from researchers, academics and think tanks. We must also move away from the current vertical approach on malaria control and empower communities and local leaders to foster sustainable solutions.

Malaria should be the pacesetter for response to other health problems. It lends itself very well to intersectoral collaboration because it has huge socio-economic impacts. Malaria has links with agriculture, the environment, household economies, it kills children and women. These are compelling reasons for governments and communities to find and implement lasting solutions. This approach works not only for malaria, but tuberculosis, maternal health and other communicable disease in Africa.

The whole of society approach and intersectoral collaboration will get us back on track. Success is not possible without new a vision, collective people-led action, tools and innovation.