Q&A on Algeria’s malaria-free certification

22 May 2019

Mother getting her child tested for malaria
Early diagnosis and treatment of all malaria cases is one of the key components of Algeria's success in eliminating malaria.

Today, Algeria was officially certified by WHO as malaria-free. How did the country achieve this milestone?

Algeria has an excellent healthcare system that extends even to remote areas of the country. All healthcare services, including malaria prevention, diagnosis and treatment, are provided free of charge to anyone within its borders including migrants.

After eliminating indigenous malaria from the northern provinces of the country in 1993, Algeria shifted its focus south, where increased migration from neighbouring, malaria-endemic countries posed a key challenge to elimination efforts.

Following the completion of the Algerian segment of the Trans-Saharan Highway in 1977, which linked Algeria to sub-Saharan Africa, population movement in neighbouring malaria-endemic countries contributed to increased transmission in Algeria’s southern provinces, resulting in several outbreaks of malaria in border areas; between 1977 and 2008, the annual number of malaria cases in Algeria rose from zero to an average of 250.

Algeria was able to control and prevent sustained transmission of malaria through a robust, integrated surveillance system, a well-trained health workforce, effective vector control, universal health care, and a rapid response to outbreaks of the disease. In 2013, the country reported its last indigenous case of malaria.

What systems and strategies has Algeria adopted to stay malaria-free?

The high quality of Algeria’s health system, coupled with the provision of free healthcare to everyone within its borders, will allow for effective prevention measures, as well as early diagnosis and treatment of all malaria cases.

Faced with a significant rate of imported malaria cases from neighboring malaria-affected countries, particularly in the south, Algeria’s healthcare personnel will need to remain vigilant: suspected cases of malaria must be rapidly identified, tested and treated to prevent local disease transmission.

The investigation of malaria cases by trained personnel, vector surveillance, and effective oversight by provincial and national health experts will help ensure that any local cases are quickly identified, and that appropriate actions are taken to prevent re-establishment of transmission.

What role did national leadership play in this success story? Did international partners also contribute to this effort?

The commitment, leadership and expertise of 3 national partners – Algeria’s Ministry of Health, Population and Hospital Reform, the National Institute of Public Health, and the Pasteur Institute of Algeria – were essential to achieving this success. Through a collaborative effort that engaged additional academic partners, these 3 government agencies successfully implemented and monitored the country’s malaria elimination programme.

The long-standing financial support of the national government was also key to success: Algeria has always fully funded its budget for malaria elimination through domestic financing.

WHO at all levels has been a critical technical partner, especially in the last 3-year period (2016-2018) when the country was seeking elimination certification. WHO supported national efforts to update strategies and guidance on both malaria elimination and on the prevention of re-establishment of transmission.

How can Algeria be certified when it is bordered by three malaria-endemic countries and receiving hundreds of imported cases each year?

Algeria reported its last indigenous case of malaria in 2013. Since that time, the country has proven capable of detecting, treating and responding to all imported malaria cases rapidly enough to prevent indigenous transmission from occurring.

The presence of so many imported cases each year helps to keep Algeria’s healthcare system vigilant to the threat posed by malaria. It also helps maintain skills in diagnostic testing and treatment among health care personnel.

Algeria’s open and accessible healthcare system means that visitors and migrants will be encouraged to seek and receive treatment any time they fall ill, reducing the chances that imported cases will go unnoticed and untreated.

How does Algeria stand to benefit from its new malaria-free status?

Certification provides external validation that Algeria’s health care system is strong enough to eliminate a significant public health burden, and that the population of Algeria is no longer at risk of illness or death from this serious disease. In view of its malaria-free status, Algeria is expected to benefit from a growth in tourism and development in the country’s southern provinces.