Ten countries included in a $10-million Global Fund regional initiative spanning Mesoamerica and Hispaniola met on 28 February to develop new ways to evolve national malaria strategies away from control towards pre-elimination and elimination of the disease. The countries have set a regional goal to eliminate malaria by 2020.
Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala Haiti, Honduras, Mexico, Nicaragua and Panama all sent representatives to the meeting co-sponsored by ISGlobal and the Council of Ministers of Health of Central America and Dominican Republic (COMISCA).
Malaria remains a significant problem in the region, with both public health and economic consequences for countries that rely chiefly on agriculture and tourism as their primary sources of income.
Central America has achieved the 2015 Millennium Development Goal target of a 75% reduction in cases, with a general decline of some 88.1% in morbidity from malaria between 2000 and 2012.
However, both sides of the Caribbean island of Hispaniola – Haiti and Dominican Republic – have reported an increased incidence since 2011. Haiti, the only low-income country in the region, accounts for the majority of the new cases reported. According to the WHO World Malaria Report, the entire population of Haiti is at risk of malaria, with nearly half (47%) at high risk.
Individual countries have developed their own strategies befitting the phase in their malaria response, with Honduras, Belize, Nicaragua, Panama and Guatemala in the control phase and others, such as Costa Rica, El Salvador and Mexico, in a pre-elimination phase. Reported malaria cases in Haiti and the Dominican Republic increased from 18,130 in 2000 to 33,664 in 2011. In recent years, most cases have been diagnosed in Haiti or have been imported from Haiti to Dominican Republic, where the numbers of reported cases has increased in the past few years (from 2,711 in 2007 to 952 in 2012).
The collection of reliable baseline data has been identified as one of the core elements of the EMMIE initiative in order to ensure that countries are on track to achieve their individual targets as well as the regional targets of elimination by 2020.
The Global Fund Board approved a recommendation on 28 February to invest $10.2 million in the initiative including $1.2 million to be spent in six of the 10 countries to strengthen malaria surveillance systems and improve data that will be used to set new baselines and targets. A grant agreement has been sent to the current principal recipient, Population Services International (PSI) and to the various regional stakeholders for signing, which is anticipated for end-March.
Those data will be used to set national-level baselines and targets with PSI following verification by an independent external institution.
Other elements of the EMMIE initiative include:
- Supporting the standardization of case management best practice for malaria, to ensure proper diagnosis and timely treatment
- Supporting the standardization of an agreed protocol for integrated vector management
- Facilitating cross-border cooperation and regional coordination
- Establishing a regional operational research framework for guiding and facilitating the implementation of elimination strategies
Baseline data, based on key health indicators, will reflect the current context in each country as it guides program strategies for improved civil society participation in outreach and awareness campaigns: the sixth pillar of the regional initiative. Each country will be expected to report on ‘confirmed malaria cases’ over the course of the initiative as a way to monitor progress towards elimination.