The fight towards malaria elimination in Central America and Hispaniola

The Covid-19 pandemic has disrupted everybody´s lives in different ways. For public health organizations, such as the Clinton Health Access Initiative (CHAI), it´s paramount to keep looking for the right balance between the human resources and beneficiaries' health and the continuous progress towards their objectives, in this case, malaria elimination.

Each year, nearly 220 million people become sick with malaria worldwide, causing over 400,000 deaths. Malaria is a debilitating, sometimes deadly, parasitic disease spread by certain species of mosquitos. Although funding for malaria significantly increased from 2000 to 2017, resulting in a 48 percent decline in malaria-related deaths, these gains may not be sustainable. The history of anti-malarial efforts clearly demonstrates how the threats of vector and parasite resistance, donor fatigue, and programmatic or community complacency will eventually reverse progress unless additional efforts are undertaken. Making further gains will require an increased focus on improving the efficiency and effectiveness of available resources through government-owned disease surveillance and response systems.

Clinton Health Access Initiative (CHAI), among other initiatives, supports countries throughout Africa, Central America, Hispaniola, and Southeast Asia to accelerate progress toward malaria elimination by strengthening disease surveillance, improving management processes, and increasing access to optimal tools that limit transmission, cure disease, and prevent deaths, looking to create and maintain high quality health systems that can be successful without their assistance. More information in CHAI´s 2018 Annual Report.

Work in Central America and Hispaniola begun in 2014. Today, CHAI is supporting the governments of Panama, Honduras, Guatemala, Haiti, and the Dominican Republic to work toward the goal of malaria elimination, all coordinated from their regional office in The City of Knowledge, where they are members since 2017.

Central America and the Caribbean have also made significant progress in reducing malaria in the past two decades. In eight of the ten malaria-eliminating countries in this region, cases have declined between 90% and 99% since 2000. CHAI has provided direct, targeted technical support to national malaria programs in Central America and Hispaniola to help them reorient from their prior control strategies towards those suitable for achieving sustainable elimination in the coming years. The results of this work suggest that a prompt elimination is possible throughout the region, but programs will need to improve surveillance systems and disease intelligence.

Despite this progress, the de-prioritization of malaria programs due to the increasing threats of dengue, Zika and other diseases, jeopardizes achievement of this fully obtainable goal. Making the final push to achieve sustainable elimination will require external resources and support to keep efforts focused on finishing the job in the short term, freeing up health systems and financial resources to shift focus on new threats.

With this idea, CHAI was instrumental in the development of the recent Regional Malaria Elimination Initiative (RMEI), which is a joint effort between the Bill & Melinda Gates Foundation (BMGF), the Inter-American Development Bank (IADB), The Global Fund to fight HIV/AIDS, TB and Malaria; The Carlos Slim Foundation, the Pan American Health Organization (PAHO), The Council of Ministers of Health of Central America (COMISCA), and CHAI. The RMEI will provide more than $100 million, that will add to the amount provided by the governments in the region and by the Global Fund against AIDS, Tuberculosis and Malaria. According to IDB´s website: “these resources will guarantee that the fight against malaria will be kept as a health and development priority, beyond the falling if registered cases. In the same way, it will help to close the technical and financial gaps to bring forward the national eradication plans in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic”. The initiative will also complement the existing efforts to eliminate malaria in Haiti, by the Haitian government and the Malaria Zero Alliance.

CHAI’s work within the RMEI is focused on helping the programs better understand the final pockets of transmission and targeting tailored interventions to those specific locations, supported by epidemiological surveillance, vector control and case management with the help of Community Health Workers (CHWs).

Significant progress was made in Panama, where CHAI continued to support implementation of an innovative healthcare model in the Guna communities, where the few remaining cases of malaria are concentrated. Results from the first year of implementation showed that the community healthcare worker (CHW) network built by CHAI is significantly improving diagnosis and treatment in Guna Yala, Wargandi and Madungandi. This success facilitated approval for CHAI to expand the approach to the Ngabe Bugle comarca. In the same way, CHAI has created or strengthened Community Health Worker networks in specific localities of other countries in the region, such as Gracias a Dios in Honduras and Escuintla in Guatemala.

To avoid halting the efforts towards malaria elimination, CHAI is providing personal protective equipment (PPE) to safeguard the Community Health Workers and the Vector Control Technicians, who are on the frontline against the disease; in the same manner as to protect the beneficiaries of the treatments. 

For more information about CHAI´s work in the region and open positions, please visit www.clintonhealthaccess.org/mesoamerica-hispaniola