5 Oct 2015

Elimination 8 (E8) has set the formidable target of full malaria elimination in Botswana, Namibia, South Africa and Swaziland by 2020. Termed the “frontline four”, these countries are nearing elimination of the disease after achieving a 75% decline between 2000 and 2012. According to the most recent World Malaria Report, incidence is now as low as 0.25-2.13 (per 1000 population) in these four countries.

The E8 is a regional partnership of the following eight countries: Angola, Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. It is designed to serve as a platform for joint planning, negotiation, and accountability towards a regionally synchronized malaria elimination effort.

The Global Fund approved $17.8 million for the E8 grant in September based on a recommendation from its Grant Approvals Committee (see GFO article).

Elimination in the frontline four is expected to pave the way for a subsequent elimination drive in the “second line” countries (Angola, Mozambique, Zambia and Zimbabwe), where incidence of malaria is much higher. Activities delivered through the E8’s Global Fund program are anticipated to allow seven districts of southern Zimbabwe to achieve zero local transmission as soon as 2017.

If the E8’s elimination targets are achieved, they would go a long way towards kick-starting progress on the Sustainable Development Goals (SDGs). One of the sub-targets within the SDG for health includes ending the global malaria epidemic by 2030.

Dr. Richard Kamwi (former Minister of Health and Social Services in Namibia, founding Chairperson of the E8 Ministerial Committee and current E8 Ambassador), told Aidspan that eliminating the local transmission of malaria within the E8 countries is an ambitious but attainable goal. “It is a goal whose success is anchored in meaningful and strategic coordination among the eight countries,” Kamwi said. “Together as a region we must join efforts in combatting this disease as a united force.”

The main thrust of the E8 regional program is to expand access to early diagnosis and treatment for mobile and underserved populations in the border areas. A regional approach is required because the frontline four will be unlikely to achieve elimination if malaria is not sufficiently controlled in their northern neighbors. In other words, there is a need to reduce the reservoir of infection in the second line countries, since it contributes to the importation of malaria into eliminating areas. This is largely linked to the region’s high volume migration patterns (Figure 1). “We are very aware that the increasing level of population movement across porous country borders necessitates a joint approach to fighting malaria,” says Dr. Kamwi.

Figure 1: Volume of human migration (left) and malaria transmission in the E8 (right)

Source(s): Elimination 8 Regional Concept Note (left) and Roll Back Malaria & SADC E8 Overview (right)

More than a third of the total requested budget is earmarked for setting up malaria posts in border districts to provide improved case management to transient communities. The program also aims to set up a regional surveillance system to develop better intelligence on regional transmission patterns and the extent to which transmission patterns are linked. Outcomes of these activities include the diagnosis of approximately 1.5 million people, and treatment of 34,000 cases.

Ms. Kudzai Makomva, Director of the E8 Secretariat, led the development of the E8 strategic plan and Global Fund concept note. According to Makomva, the Global Fund grant provides an important opportunity for proof of concept of this specific set of border-focused interventions. “Countries have been discussing cross-border collaboration for some time,” she said. “Now, with these resources, we will be able to demonstrate how strategies like border surveillance and expanded testing capacity can limit importation and eliminate remaining foci in the frontline countries.”

This will be the first Global Fund grant managed by the E8 Secretariat, the program’s principal recipient (PR). Established in 2009, the E8 is a relatively new organization and is in the infancy of implementing its strategic plan. Based on this, at the start of the grant disbursements will be conservative and will scale once operational plans have been finalized.

There are several areas of alignment between the E8 program and other Global Fund regional grants. The TB in Mines program also seeks to address health challenge associated with the high levels of interconnectedness and cross-border movement in Southern Africa. Coordination between these two regional programs is likely necessary, and may even be an opportunity for added efficiency gains. For instance, both programs seek to improve tracking and tracing of vulnerable migrant populations, many of which are susceptible to both TB and malaria.

The E8 regional grant is already demonstrating its ability to leverage additional resources from governments, promoting shared responsibility and sustainability. The national malaria control programs of the E8 countries have pledged to contribute an estimated $5.7 million in domestic resources to support regional activities over the three-year grant cycle. Further, Ministers of Health from the Southern African Development Community (SADC) have committed to exploring the establishment of a regional trust fund for malaria and other regional health priorities. 

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