Beating back malaria in Africa: challenges and opportunities

Q&A with Dr Matshidiso Moeti, WHO Regional Director for Africa

23 April 2018

This interview has been edited and condensed from the audio version (Duration 12:11 [mp3 27 Mb])

As noted in WHO’s latest World malaria report, the pace of progress in the global malaria response has stalled in recent years. Many countries are not on track to achieve the targets of the Global Technical Strategy for Malaria 2016-2030. Fifteen countries, all but one in sub-Saharan Africa, together carry 80% of the global malaria burden. What roadblocks are these countries facing and what opportunities could be leveraged to turn the story around? Dr Matshidiso Moeti, WHO’s top official in Africa, shares her views.

Accelerating progress in Africa will be critical to achieving our ultimate goal: a world free of malaria (animated illustration)

Dr Moeti, what have been some of the most significant public health gains in Africa during your 35-year career in public health?

First of all, I think the understanding, the knowledge and the acceptance of public health and the approach has grown. We’ve seen tremendous improvements in child mortality in the African region; child deaths under 5 have been significantly reduced. We’ve also seen dramatic decreases in HIV-related mortality. When I was an official in the Ministry of Health in Botswana, it was pre-treatment and people were dying every day. There was absolute despair on the continent about HIV.

This has been completely turned around, and HIV-related mortality has been significantly reduced. I do think that the Millennium Development Goals helped to drive some of these changes. Some countries put a lot of effort into trying to improve their health systems to deliver better care and prevention interventions to populations.

So, it’s been a very positive picture in the African region: ambitious targets spurred tremendous action in countries. This is what I’ve seen in my 35 years in public health.

The fight against malaria has been another success story, and yet we’re hitting a plateau at this point saying that progress has stalled or slowed in recent years. Africa continues to carry about 90% of the disease burden. Why is Africa bearing the brunt of this disease?

Yes, this is a considerable challenge in the African region. First, there continue to be significant gaps in the implementation and delivery of malaria interventions in many of our countries. For example, WHO recommends intermittent preventative treatment in pregnancy (IPTp), but only about 19% of eligible pregnant women received the recommended 3 or more doses of IPTp in 2016 in the African region.

In addition, access to seasonal malaria chemoprevention for children has not expanded as rapidly as we would have liked to see. So, although we have managed to protect 15 million children in 12 countries through this intervention in the African region, we still have 13 million children who could have benefited from seasonal malaria chemoprevention programmes who are left behind, mainly because the funding was inadequate to provide this service to them. Also, only 19% of children under 5 seeking care received artemisinin-based combination therapy in African countries.

Funding for malaria is not keeping abreast with the level of ambition expressed in the Global Technical Strategy. Funding is plateauing and there is a challenge with having predictable and sustainable domestic funding to supplement the international funding that’s available for malaria prevention and control, which is necessary to sustain the gains that have been made in the region.

And finally, we do have relatively weak health systems in the region and this is related particularly to investments in health that are not yet adequate in African countries. They have increased, but have not reached the per capita level recommended by WHO to enable countries to deliver a basic essential healthcare package for prevention and treatment for their populations, including very importantly for malaria.

Your work as the WHO Regional Director for the African region takes you to meetings with decision-makers across Africa. With many governments facing competing health and other sustainable development priorities, what do you say to African leaders to keep their focus on malaria, and importantly, to contribute domestic resources to combatting the disease?

The key message, first of all, is to increase financing for health generally. We focus on the fact that much of the global burden of malaria is in the African region. We as a region – our national leaders and our governments – have to make the necessary efforts to increase funding for health but also recognize that malaria prevention and treatment is a good investment.

If you look at the scale of the malaria problem, the impact that it has on daily lives in families, and if you look at the opportunities and savings offered by managing malaria so that we reduce the length of illness and, most importantly, we reduce deaths, there is no doubt that there could be significant economic savings for countries.

Finally, I remind leaders that we have benefited from international solidarity, from international funding like the Global Fund, the United States President’s Malaria Initiative, and we as African countries need to invest also to complement this funding so that this action can be sustained.

WHO’s World malaria report 2017 showed that more people at risk of malaria in Africa are now sleeping under insecticide-treated nets. What are some of the other positive aspects and advances that we are seeing in African countries that we can show as a positive result already?

Yes, we are seeing that progress is being made and, if we scale up, we will start to reap the benefits of the targets that have been set. For example, we are seeing that the adoption of new diagnostic tools in the public sector has been very significant. African countries have been able to adopt these tools and take them up particularly in the public sector to a reasonable degree so that they become available to populations and they have an impact on health outcomes.

We’ve observed in terms of diagnostics, and in terms of using the correct treatment, that where countries have adopted an integrated approach to managing illness, particularly in children but also in adults, the adoption of effective malaria interventions also speeds up.

However, governments can’t do this work alone. Nongovernmental organizations, those that are working at the community level, as well as the international community, and WHO, all play a key role in improving the situation.

A malaria vaccine for children has been recommended by WHO for pilot introduction in selected areas of Ghana, Kenya and Malawi. Could this be a game-changer in fighting the disease?

The development of the vaccine presents a new frontier in the fight against malaria. It’s an important complementary tool to the other interventions that we’ve already been talking about that could potentially really change the current disease landscape. We know that the vaccine has partial efficacy and it prevents about 4 cases in every 10, but since malaria is such a common cause of illness and death it can potentially make a considerable impact on public health when added to the other malaria control measures that are already in place in countries with moderate and high malaria transmission.

WHO is celebrating its 70th anniversary this year. What are your thoughts on the road ahead for public health and for WHO in particular?

WHO has come a very long way and has had to adapt to the changing context in global health. This has been discussed very recently in the context of some of the big challenges that we have seen in health. I am very happy to note that the organization is tackling some of the changes that need to happen.

At the moment, as people might know, WHO is engaged in developing a new strategy for the next 5 years under the leadership of our new Director-General where we are refining our vision for a focus on delivering results. All the work that we do, at the end of the day, has to find effective expression and implementation in countries to make the difference in people’s lives and in saving people’s lives.

I see all of this coming together in a way that is going to make our work in WHO very exciting although very challenging in the next few years. I’m very optimistic about the direction that we are taking.

Dr Moeti was interviewed by WHO Communications Officer, Nyka Alexander, from the Organization’s headquarters in Geneva.