The final hand-to-hand and house-to-house combat against malaria


Deaths due to malaria have been reduced in Central America by 90% in 15 years. The goal for 2020 is that the number becomes zero


The war against malaria has entered its final battle in Central America and the South of Mexico. In the year 1900, practically all countries around the world suffered cases of malaria, a disease that was first described in China over 4,000 years ago, but it was by the middle part of the twentieth century when the fight against it became part of the policy agenda of Health Ministries around the world, supported by diverse international efforts. It was in the nineties when clear results began to be observed. Since 1997, the trend of malaria cases in America has dropped by an annual rate of 7% and, in the case of Central American countries, malaria cases dropped by over 90% between 2000 and 2015.

However, as in all great feats, the last tranches are the most complex to face. When it seemed that the final defeat of this disease was within our grasp, the parasite has regained terrain in a worrisome manner. In 2016, all alarms went off. For the first time in practically half a century, cases of this disease were increasing. According to the Pan American Health Organization, nine countries (Colombia, Ecuador, El Salvador, Guyana, Haiti, Honduras, Nicaragua, Panama and Venezuela) notified an increase in cases in 2016. Some 40,000 cases were recorded in Central America in 2016, reaching a total of 875,000 in all Latin America and the Caribbean.

The malaria parasite has shown that it’s defeat will be costly. All efforts made so far have weakened it and isolated it in clearly outlined geographical points, but have been insufficient to eliminate it. Notwithstanding, 2018 may be a decisive year. A new initiative with a public, private and multilateral organizations partnership seeks to completely eliminate malaria by 2020 in Mexico, Guatemala, Belize, Honduras, Nicaragua, El Salvador, Costa Rica, Panama, the Dominican Republic and Colombia. This initiative aims to demonstrate that the eradication of malaria is possible. However, to achieve this, the parasite has to be chased and neutralized, one by one, wherever it is found, including the remotest places. A hand-to-hand and house-to-house battle.

The Regional Malaria Elimination Initiative, managed by the Inter-American Development Bank (IDB), counts with an 83 million Dollar budget for the next five years. The partners in this initiative are: Pan American Health Organization (PAHO), Clinton Health Access Initiative (CHAI), the Council of Ministers of Health from Central America (Comisca) and the Mesoamerica Project. The sponsorship comes from the Carlos Slim Foundation, the Bill & Melinda Gates Foundation and the Global Fund.

The Project will focus on detecting, one by one, all malaria cases in the main transmission focuses of this disease in the Mesoamerican Region, the Dominican Republic and Colombia, where 80% of the cases have been recorded. A whole network of entomologists, epidemiologists, physicians, health promoters and volunteers whose main goal will be to detect every case of malaria that takes place at transmission focuses in less than 48 hours and apply treatment in under one day. In other words, prevent the malaria parasite from staying in the human body for more than 72 hours. The strategy consists in breaking the disease transmission cycle among humans in the first hours of contagion. The project will imply great training and education efforts, as well as communication among citizens living in the main transmission focuses so that they can quickly detect and treat every person with the disease.

The challenge, on the one hand, is logistics, since it will imply contracting important human resources and the distribution, to remote places, of medical supplies such as laboratory tests, mosquito nets, insecticides, medicines… Above all, it will imply a great challenge in terms of work systems and coordination with the countries’ governments. To that end, the program will be financed with the same results-based financing model that has been implemented in the Salud Mesoamérica Initiative and that has served to achieve important and quick progress in maternal and child health among the most vulnerable population of the sub-region.

The Inter-American Development Bank, as general manager of the Initiative, will agree with the countries on the establishment of 10 indicators that evaluate the evolution of measures aimed at identifying malaria cases in 48 hours and treatment in less than 24. Their compliance will allow the countries to achieve the elimination of malaria by 2020; when they achieve zero cases in 2020 they will also obtain a financial incentive. This financing model will allow the achievement of collective impacts, introduce new technical focuses, ensure the leveraging of national funds, accelerate the rate of interventions, analyze data and use the information for executable actions and, most importantly, guarantee a quick diagnosis network, mosquito repellants and medicines that allow the treatment of detected cases in less than 24 hours.

The last effort to eliminate malaria will imply individualized monitoring, case by case. It will be a titanic task, but the institutions involved in this process are determined to achieve them. Every year 450,000 persons around the world die from this disease, primarily in vulnerable and socially marginalized zones. But malaria can be defeated and we are going to prove it.

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Iniciativa Salud Mesoamérica 2015
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international cooperation
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