Eliminating malaria from the margins of transmission in Southern Africa through the Elimination 8 Initiative

Abstract

Four southern Africa countries, namely, Botswana, Eswatini, Namibia and South Africa, were identified by the World Health Organization as having the potential to eliminate malaria in the near future. However, the extreme interconnectedness of southern African countries facilitates the constant movement of malaria parasites across country-borders, predominately from higher-burden “source” countries to lower-burden “sink” countries, reinforcing the notion that malaria elimination in any southern African country would not be possible without regional cooperation and collaboration. The Elimination 8 initiative (E8) was therefore, created by Health Ministers from eight countries (Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia and Zimbabwe) to coordinate the implementation of a regional malaria elimination strategy. The E8 supported the implementation of five cross-border malaria control initiatives and the deployment of malaria health units at strategic points along shared borders. These units have contributed to a 30% and 46% reduction in malaria incidence and mortality, respectively, in the E8 border regions. The Situation Room, a novel data sharing platform developed and supported by the E8, has allowed for the early detection of and prompt response to malaria outbreaks. This platform played a vital role in identifying resources gaps due to the COVID-19 pandemic. Despite advancing the elimination agenda, the E8 region faces challenges which include, significant increases in malaria in certain member states, limited domestic funding and health system bottlenecks. These must be urgently addressed if the gains made through the E8 are to be sustained and malaria elimination is to be achieved across southern Africa.