Sri Lanka: Long Battle to Eliminate Malaria

Abstract

AbstractSri Lanka was certified by WHO for having eliminated malaria on 5 September 2016. The elimination of malaria brings to an end one of Sri Lanka's most devastating health burdens. Malaria epidemics and endemic transmission in Sri Lanka had intensified in the nineteenth and twentieth centuries as plantation, irrigation and agricultural projects—undertaken by the British colonial administration and then by the independent government—opened up forested areas. Major epidemics occurred every few years. The 1934–35 epidemic killed over 1·5% of the population. Sri Lanka’s malaria elimination efforts had several key elements, including strengthened surveillance, active case investigation, comprehensive case management and health education. The introduction of long-lasting insecticide nets and the technical strategy of replacing single vector-control methods in the 1980s proved to be a critical turning point. Perhaps the most remarkable aspect of Sri Lanka’s elimination of malaria is that the foundation for this achievement was laid during a protracted armed conflict between the government and the Liberation Tigers of Tamil Eelam (LTTE). Above all, these efforts were made possible and could be sustained as a result of strong and enduring political commitment, which ensured robust funding for malaria control even when resources were scarce. The story of malaria elimination in Sri Lanka has the potential to not only inspire other countries of the Region but to serve as a guide for them on optimal strategic and operational pathways they can adopt to banish malaria.