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By April, some of the world’s leading RDT suppliers announced plans to reallocate manufacturing capacity away from malaria RDTs and towards the production of COVID-19 tests.
To avoid a potentially devastating shortfall of more than 100 million RDTs, the malaria RDT task force, which involves 15 organizations,1 began immediate discussion with suppliers that led to the convening of a June 2020, attended by suppliers’ summit 12 companies,2 including all major manufacturers. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In response, the Global Fund and PMI announced tenders to secure unallocated volumes for the remainder of 2020, allowing some flexibility in price offers.
The floating of these tenders in July and August secured the malaria RDT requirements for the remainder of 2020, minimizing the risk of stockouts. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Since then, PMI and the Global Fund have been expanding their collaborative focus “downstream”, tracking RDT supply levels in countries they support and, together with UNICEF and UNDP, coordinating orders and deliveries to minimize disruptions at the country level (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.3).in 10.3.4 Resolving global manufacturing bottlenecks for malaria medicinesIn February 2020, preliminary results from small trials employing CQ and hydroxychloroquine (HCQ) for COVID-19 treatment created high expectations for the therapeutic and prophylactic properties of these medicines. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
These early expectations led to CQ/HCQ treatment of hospitalized COVID-19 patients, and multiple stockpiling initiatives nationally and globally, fed in part by interest from the media, the general public and heads of governments.
Unregulated demand by consumers instances of cardiotoxicity and death through self-administration of these medicines in several countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The massive spike in demand for these medicines – normally used for the treatment of P. vivax malaria, and conditions such as rheumatoid arthritis and lupus – generated high demand for their active pharmaceutical ingredients.
Sales of a key starting material (4,7-dichloroquinoline) increased up to sixfold from April to June 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This key starting material is essential for producing other led to antimalarial drugs, such as piperaquine and amodiaquine; thus, the supply of other critical treatments was also artemisinin-combination constrained.
At the time of spike in demand, a major donor sought to ensure that over 120 million tablets of CQ would remain available for deployment for COVID-19 treatment in LMICs, after WHO validation of properly conducted solidarity trials. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Following the release of data showing no benefits of CQ/HCQ for COVID-19, these medicines have been donated to countries in need of CQ for treating their high burden of P. vivax malaria (e.g.
in Ethiopia, India and certain countries in Latin America).FIG.
10.3.Potential RDT stockouts forecast in June 2020, if country orders were not delivered The July tenders address all but the immediate stockouts through early 2021. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Sources: PMI and Global Fund.■ Angola ■ Benin ■ Burkina Faso ■ Burundi ■ Cambodia ■ Cameroon ■ Democratic Republic of the Congo ■ Côte d’Ivoire ■ Ethiopia ■ Ghana ■ Guinea ■ Kenya ■ Lao People’s Democratic Republic ■ Liberia ■ Madagascar ■ Malawi ■ Mali ■ Mozambique ■ Myanmar ■ Niger ■ Nigeria ■ Rwanda ■ Senegal ■ Sierra Leone ■ Thailand ■ Uganda ■ United Republic of Tanzania ■ Zambia ■ Zimbabwe)noillim(stuokcotsTDR2016128401 Bill & Melinda Gates Foundation; Clinton Health Access Initiative (CHAI); FIND; Global Fund; Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM); Médecins Sans Frontières (MSF); PATH; PMI; RBM Partnership to End Malaria; UNDP; UNICEF; Unitaid; US CDC; USAID; and WHO GMP and WHO Prequalification Programme.2 Abbott, Access Bio Inc., Advy Chemicals, Arkray, Hangzhou Biotest, J. Mitra, Meril, Mologic, Premier Medical Corp, Rapigen, SD Biosensor and Tulip Group.96JunJulAugSep2020OctNovDecJanFebMarAprMayJun2021Global Fund: Global Fund to Fight AIDS, Tuberculosis and Malaria; PMI: President’s Malaria Initiative; RDT: rapid diagnostic test.97WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemic10.3.5 Mitigating the disruptions in the shipment and delivery of malaria commoditiesThe COVID-19 pandemic also impacted ITNs and insecticides for IRS, affecting the availability of raw starting materials and production, and the shipment or movement of product between and within countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Increasing costs of raw materials and freight for many manufacturers, especially in India, could no longer be absorbed in the price of final products.
Lockdown measures in countries led to increasing restrictions that limited movement of people and goods; these in turn affected the timely production, packaging, shipment, customs clearance and in-country delivery of goods from countries of manufacture to customer countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Requirements for COVID-19 testing of drivers who transport goods across borders led to backlogs at ports and borders, and delayed import of goods.
Similar factors delayed pre-shipment inspection by limiting movement of personnel.
Quality assurance and quality control for ITNs and insecticides were also delayed due to closed laboratories. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The availability of and prices for procuring personal protective equipment (PPE) were also affected by the COVID-19 pandemic, because there was high national and international demand for these supplies, especially for N95 masks, which are essential for sprayers engaged in IRS campaigns in 2020 and early 2021. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The collaboration of over 20 organizations in tracking progress in ITN and IRS campaigns led to early resolution of bottlenecks, coordinated procurement and delivery, and mobilization of resources for PPE.10.3.6 Supplementing funding for countriesThe Global Fund has established an overall response fund of US$ 1 billion, and has allowed countries to access an amount equivalent to up to 10% of their allocations to help with the response (149). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This support includes providing funding to countries to purchase personal protective equipment such as masks, gloves and gowns that are critical for the continuation of non-COVID-19 health care services including malaria.
PMI, the second largest donor to the fight against malaria, has also made significant investments, particularly across its 24 focus countries in sub-Saharan Africa (including in all the HBHI African countries). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The investments are for both for enhanced routine programming and flexibilities within existing allocation, to help countries support and adapt their malaria programmes while responding to their COVID-19 situation. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Additional specific resource mobilization has also been supported by several other partners.110.3.7 Tracking malaria service disruptions during the COVID-19 pandemicCOVID-19 overwhelmed health delivery systems across the world, requiring adaptation or, in some cases, suspension of routine and elective services.
However, many countries are compromised by the lack of accurate and timely data for tracking and monitoring the extent of disruptions to essential health services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This is limiting the understanding of the scale of the problem and hampering the development of locally appropriate mitigation strategies.
A range of global trackers, implemented at different intervals, have been developed by various agencies to monitor disruptions in broader essential health services during the COVID-19 pandemic, including some developed specifically for malaria. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Information from these trackers was assembled to inform the level of malaria service disruption by country.2 Trackers, other than those for campaign-type interventions, had important limitations related to periodicity, scope and reliability.
In particular, information on disruptions of clinical management of malaria (diagnosis and treatment) was not adequately captured by all the trackers.
Where attempts were made to capture such information, the responses were qualitative and difficult to validate. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This exercise highlights the need to ensure that countries’ health information systems can capture critical data elements related to service disruptions and mechanisms, and complement these with low-cost sentinel surveillance and rapid community surveys.10.4 COUNTRY RESPONSES TO MITIGATE GLOBAL SERVICE DISRUPTIONSSeveral malaria endemic countries with moderate or high transmission had plans to implement campaigns to distribute LLINs, IRS and SMC in 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The COVID-19 pandemic threatened the safe and effective delivery of these interventions.
Faced with the possibility that most of the gains over the past 20 years could be reversed in a single year if major malaria intervention programmes were disrupted (Section 10.3.2), many malaria endemic countries mounted an impressive response by adapting service delivery approaches while still adhering to the restrictions imposed by national attempts to curb the spread of SARS-CoV2 infections. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The guidance provided by the WHO GMP (with support from partners) (148) coupled with documents 1 RBM Partnership to End Malaria.
Best practices in mitigating the effect of COVID-19 on malaria at country and sub-regional level. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
October 2020, report in preparation.2 RBM Country/Regional Support Partner Committee (CRSPC) tracker (150), Workstream 3 trackers (ITN, IRS and SMC), RBM MERG routine data tracker (151) and WHO essential health services survey (152).98developed by partners to support implementation, were critical in helping countries tailor their responses to the COVID-19 pandemic.In their mitigation response, countries faced several challenges: lack of funds and delays in procurement of PPE; delays in procurement and delivery to country of adequate nets, insecticides, diagnostics and drugs because of global supply chain disruptions (Sections 10.3.3–10.3.5); delays in shipping due to mobility restrictions; and the need to acquire high-level political support in an environment where most of the focus was on direct efforts to fight COVID-19. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A case study of Benin, as an example of a country adapting and maintaining malaria services during the COVID-19 pandemic, is presented in Box 10.1.BOX 10.1.Benin: Country example for sustaining malaria programming during COVID-19In March 2020, the first cases of COVID-19 were recorded in Benin, just as the country was planning its LLIN campaign. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Following the WHO recommendation to continue with the implementation of malaria control interventions in the face of COVID-19 (148), and with strong support from the RBM Partnership, the Ministry of Health was authorized to continue with the implementation of the planned LLIN campaign. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Working closely with the RBM Partnership through the Alliance for Malaria Prevention (AMP), Benin’s National Malaria Control Programme reviewed and revised their distribution strategy to mitigate the risks of COVID-19 transmissiona during the campaign.
The AMP guidance for distribution of ITNs during COVID-19 transmission facilitated adaptation of the distribution strategy, with the adoption of a door-to-door distribution approach rather than distribution from a fixed point. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The change in approach meant an increase in the number of days needed for community mobilization, modifications to briefings, training and supervision, plus the purchase of PPE.
The Global Fund rapidly approved the release of funds from Benin’s existing grant to cover any increased costs. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The strong leadership from the Government of Benin, the Ministry of Health and the NMP, and effective collaboration with international and implementing partners facilitated the door-to-door distribution of 7 638 192 nets in just 20 days, ensuring that Benin’s population of 14 million were protected from malaria.
Benin was the first country to proceed with its planned LLIN campaign in the face of COVID-19, providing a valuable “proof of concept” for other countries to follow. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Other countries across Africa subsequently adopted the approach pioneered by Benin to ensure that life-saving mosquito nets were distributed.Benin also successfully conducted IRS during the COVID-19 pandemic, spraying a total of 350 349 structures.
With support from partners, the NMP updated the IRS strategy and training to include COVID-19 prevention measures. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Additional protection measures were established, including increasing the number of handwashing stations for frontline workers and provision of additional vehicles to transport spray personnel in accordance with national travel recommendations.
Measures were put in place for COVID-19 testing of spray personnel and for managing any suspected cases among the spray teams.Benin also successfully completed four rounds of SMC in four health zones. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
With support from partners, the NMP adapted the SMC strategy to include COVID-19 prevention measures.
Sensitization of communities and compliance with the government’s protective measures (wearing a mask, using sanitizing gels and physical distancing), as well as limiting the number of participants in meetings and trainings, helped to build confidence in the community.
Finally, the country has worked to sustain case management of malaria during the COVID-19 pandemic. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This has included ensuring sufficient supplies of essential malaria commodities (e.g.
diagnostics and treatment) at health facility level.
Through strong leadership, and coordinated partnership, Benin has successfully implemented the LLIN, IRS and SMC campaigns planned for 2020, while working to sustain access to case management. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
All this has been achieved under the very difficult circumstances of the COVID-19 pandemic.a https://allianceformalariaprevention.com/wp-content/uploads/2020/10/Key-guidance-EN.pdf99WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemic10.5 LEVELS OF SERVICE DISRUPTION BY COUNTRY AND IMPLICATIONS FOR DELIVERY OF INTERVENTIONSAccording to available information,1 all 31 countries (25 in sub-Saharan Africa) that had ITN campaigns planned in 2020 aimed to complete them by the end of the year. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
As of 23 November 2020, five countries had completed on time (within the planned period before the pandemic), seven had completed with moderate delays (within the second quarter of the original planned period), 12 had ongoing campaigns with moderate delays, and another seven had campaigns in progress but with major delays (beyond the second quarter of the original planned period).
Of the 222 million ITNs expected to be distributed in 2020, 105 million had been distributed by 23 November 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Of the 47 countries that planned IRS campaigns in 2020, 23 had completed them, with eight of those countries doing so with delays.
Thirteen countries are on track to complete their IRS campaigns, six of them with delays.
Eleven countries, eight of them in sub-Saharan Africa, were either off track or at risk of not completing their IRS campaigns. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
By the third week of November 2020, all countries that had planned SMC campaigns were on track to complete them, despite moderate delays in some areas.1 RBM Country/Regional Support Partner Committee (CRSPC) tracker (150) and Workstream 3 trackers (ITN, IRS and SMC).FIG.
10.4.Results from WHO surveys on disruptions of malaria-related services during the COVID-19 pandemic: a) ANC services and b) diagnosis and treatment No disruption (<5%); partial disruption (< 50%); severe disruption (>50%). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Surveys were conducted in May-September 2020 Sources: WHO Integrated Health Services.Understanding the disruptions in malaria case management is difficult because it requires data from multiple household surveys of disruptions to treatment seeking for fevers, combined with information at health facility level about changes in patient caseloads.
In addition, disruptions varied greatly within countries by geography and over time, making it difficult to draw conclusions from point-in-time data. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
These data should be combined with detailed country information on supply chains, and stockouts of diagnosis and treatment commodities in order to identify not only disruptions but also their potential causes and solutions.
In the absence of such data, several proxies have been explored.
Figure 10.4 shows responses from countries on the extent of disruptions of malaria diagnosis and treatment, collected through the WHO Essential Health Service pulse survey from mid-May to September 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The findings suggest that among the 64 malaria endemic countries that responded, 39 experienced partial disruption (of between 5% and 50%) of ANC services (Fig.
10.4a), and 37 experienced similar disruptions of malaria diagnosis and treatment (Fig.
10.4b).
Djibouti reported severe disruptions of ANC services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This information is similar to that shown on other more recent surveys implemented by the Global Fund (153), suggesting that most malaria endemic countries surveyed have experienced at least moderate levels of a) ANC services■ No disruption ■ Partial disruption ■ Severe disruption ■ Unknownb) Diagnosis and treatment■ No disruption ■ Partial disruptionAFR719AFR1116AMR97AMR88inogerOHWEMR1411inogerOHWEMR24SEAR26SEAR35WPR43WPR3051015Number of countries2025300451015Number of countries202530100AFR: WHO African Region; AMR: WHO Region of the Americas; ANC: antenatal care; EMR: WHO Eastern Mediterranean Region; SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.AFR: WHO African Region; AMR: WHO Region of the Americas; ANC: antenatal care; EMR: WHO Eastern Mediterranean Region; SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.101WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemicdisruption of malaria case management, of up to 50% based on the knowledge of the respondents.Analysis of routine aggregate data, while potentially biased by many factors related to the quality of the surveillance system, may add value to our understanding of disruptions to clinical services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Fig.
10.5 shows monthly trends in all-cause outpatients in 2019, and up to June or September 2020 in the public health sector, for 23 countries in sub-Saharan Africa. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Most of the countries show reductions in outpatient attendances from March 2020 onwards, compared with a similar period in 2019, suggesting a general decline in use of health services.A similar analysis of malaria outpatient data shows that, despite decreasing overall attendance at public health facilities, malaria cases were generally higher in 2020 than in 2019 in 10 countries, and were lower in the remaining 14 countries (Fig.
10.6). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.6).
There are several potential reasons for discordance in the trends in all-cause and malaria outpatient data, such as changes in diagnostic practice or reporting of presumptively treated cases as parasitologically confirmed.
However, a potential concern would be that there is increasing malaria transmission, whereby there is more malaria among those patients using services at a time when use of services has generally reduced due to COVID-19 disruptions.FIG.
10.5.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.6.Monthly trends in all-cause outpatients attendances in 23 countries in sub-Saharan Africa in 2019 and 2020 Source: NMP reports.Monthly trends in malaria outpatients attendances in 24 countries in sub-Saharan Africa in 2019 and 2020 Source: NMP reports.AngolaBeninBotswanaAngolaBeninBotswana2019202020192020stneitaptuoesuac-llaforebmuN5 000 0004 000 0003 000 0002 000 0001 000 0002 000 0001 500 0001 000 000500 0000150 000100 00050 00008 000 0007 500 0007 000 0006 500 0006 000 000250 000200 000150 000100 0005 000 0004 500 0004 000 0003 500 0003 000 0005 500 0005 000 0004 500 0004 000 0002 500 0002 000 0001 500 000Burkina FasoChadDemocratic Republic of the Congo300 000250 000200 000150 000100 0001 000 000500 000040 00030 00020 00010 000180 000160 000140 000120 000100 000BurundiComorosEswatini400 000300 000200 000100 0000200 000150 000100 00050 00050 00025 0000700 000600 000500 000400 000300 000Central African RepublicCongoGhanaGuineaMadagascarMalawiMozambiqueSouth AfricaZambiaNigeria2 000 0001 500 0001 000 000400300200100Sao Tome and PrincipeUnited Republic of Tanzania (mainland)United Republic of Tanzania (Zanzibar)250 000200 000150 000100 000Zimbabwe15 000 00010 000 0005 000 00002 500 0002 000 0001 500 0001 000 000500 0004 500 0004 000 0003 500 0003 000 0001 200 0001 000 000800 000600 000400 000stneitaptuoairaamlforebmuN800 000700 000600 000500 000400 0008 000 0006 000 0004 000 0002 000 0000500 000450 000400 000350 000300 0002 100 0002 050 0002 000 0001 950 0001 900 000500 000400 000300 0001 200 0001 000 000800 000600 00040 00030 00020 00010 000150010005000Burkina Faso600 000500 000400 000300 000200 0002 000 0001 500 0001 000 000500 000BurundiChadComorosDemocratic Republic of the Congo3000200010000150100500EswatiniGuineaMadagascarMozambiqueSao Tome and Principe200 000150 000100 00050 0006000400020000150010005000NamibiaUnited Republic of Tanzania (Zanzibar)Zambia1 000 000800 000600 000400 000200 0004003002001000400 000300 000200 000100 00015 00010 000500003 000 0002 500 0002 000 0001 500 0001 000 000800 000600 000400 000200 0006 000 0005 000 0004 000 0003 000 0002 000 000Central African RepublicCongoGhanaMalawiNigeria700 000600 000500 000400 000100 00050 0000ZimbabweSouth AfricaUnited Republic of Tanzania (mainland)123456789 10 11 12123456789 10 11 12123456789 10 11 12123456789 10 11 12123456789 10 11 12123456789 10 11 12NMP: national malaria programme. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Note: For Burkina Faso, monthly data from 2018 were used due to major disruptions of the surveillance system due to the 2019 health workers’ strikes in 2019.102NMP: national malaria programme. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Note: For Burkina Faso, monthly data from 2018 were used due to major disruptions of the surveillance system due to the 2019 health workers’ strikes in 2019.103WORLD MALARIA REPORT 2020 The analysis shows that, even with completion of the prevention campaigns, relatively small disruptions in access to effective antimalarial treatments (similar to those suggested by the various trackers) can lead to considerable loss of life (Fig.
10.7). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.7).
Thus, a disruption in access to treatment of 10% in sub-Saharan Africa is likely to lead to an estimated 19 000 additional deaths among people of all ages.
This is likely to increase to 28 000, 46 000 and 100 000 deaths if access is reduced by 15%, 25% and 50%, respectively. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Had the ITN, IRS and LLIN campaigns not happened in 2020 as planned, mortality would have increased several times more than currently projected.10Malaria response during the COVID-19 pandemic10.6 THE CONSEQUENCES OF SERVICE DISRUPTIONS DURING THE COVID‑19 PANDEMICThe analysis in this report of the consequences of disruption of services focuses on sub-Saharan Africa, a region that accounts for more than 90% of the burden of malaria morbidity and mortality. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Within this region, the analysis further focuses on mortality because it is assumed that most of the prevention campaigns will be completed by the end of 2020, averting major increases in cases.
Delays in the campaigns in 2020 have been included in the analysis of the effect of vector control coverage on infection and malaria cases.
Different scenarios of disruptions of access to effective antimalarial treatment were applied to each country, to estimate the number of untreated cases. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A uniform P. falciparum case fatality rate was then applied to the untreated cases, to estimate mortality by country (Annex 1).FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.7.Estimated potential increase in malaria deaths in sub-Saharan Africa (excluding Botswana, Eswatini, Namibia and South Africa) corresponding to varying levels of disruptions of access to effective antimalarial treatment Source: WHO estimates.sesacairaamlforebmundetamitsE600 000500 000400 000300 000200 000100 0000■ No disruptions in access to effective antimalarial treatment■ 10% reduction in access to effective antimalarial treatment■ 15% reduction in access to effective antimalarial treatment■ 25% reduction in access to effective antimalarial treatment■ 50% reduction in access to effective antimalarial treatment20102011201220132014201520162017201820192020WHO: World Health Organization.104105WORLD MALARIA REPORT 2020 11Key results, context and conclusionThis concluding section of the World malaria report 2020 highlights some of the progress made against malaria in the past 2 decades, calls out the major current challenges and threats (including the COVID-19 pandemic), and draws attention to opportunities for the global malaria community to work together to ensure even greater achievements in the next decade of the GTS. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
s s s11.1 KEY RESULTSFollowing years of neglect, remarkable progress was made in malaria during the MDG era and that progress should be considered one of the first great public health success stories of the millennium.
Despite modest levels of investment in research and development (R&D), new tools became available in the form of ITNs, ACTs and RDTs.
New strategies to deploy existing tools were developed, including various forms of chemoprevention (e.g. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
IPTp, IPTi and SMC), the use of community health workers and greater engagement with the private sector.
led A range of financing mechanisms were developed to augment the national investments of endemic countries: between 2000 and 2019, about US$ 39 billion was invested in the fight against malaria, of which US$ 26 billion represented funds from external donors (Section 6).
These developments to an unprecedented scale-up of effective malaria interventions (Section 7). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Over 2.2 billion ITNs, 3.1 billion ACTs and 2.7 billion RDTs have been delivered to malaria endemic countries.
In sub-Saharan Africa, between 2000 and 2019, the percentage of children aged under 5 years and of pregnant women sleeping under an ITN both increased from below 3% to over 50%.
More than 21 million children aged under 5 years have received SMC, and about 23 million (62%) pregnant women received at least one dose of IPTp in 2019 alone. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The percentage of children being diagnosed using a parasitological test increased from 14% before the large rollout of RDTs to, on average, 40% in the most recent household surveys conducted in sub-Saharan Africa.
By 2019, there were 229 million malaria cases and 409 000 deaths globally, reducing from 238 million and 736 000 since 2000, respectively.
It is estimated that 1.5 billion malaria cases and 7.6 million deaths had been averted since 2000 (Section 3). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Since 2000, 21 countries had achieved malaria free status or were certified by WHO as having interrupted malaria transmission (Section 4).
Thirty-one and 35 countries were on target for the 2020 GTS morbidity and mortality reduction targets, respectively (Section 8).
Each WHO region had shown reductions in malaria case incidence and mortality rates since 2000, and the entire WHO European Region had been free of malaria since 2015 (Section 3). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Under the HBHI approach, the 11 highest burden countries globally had concluded an intensive initial exercise to use their local data to develop and implement evidence-based subnationally tailored malaria interventions plans (Section 5).
Through support from the Global Fund and PMI, these countries are expected to receive more funding in the period 2020-2022 than in the preceding 3 years. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Despite the overall progress made in the first 15 years of this century, global trends in malaria case and mortality rates have been plateauing since 2015 (Section 3), particularly in the highest burden countries that account for most of the cases and deaths globally (Section 5).
106compliance remain challenging, and the different approaches are threatened by emerging resistance (Section 9). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The spread of resistance to insecticides used in ITNs and IRS is extensive and, although the epidemiological impact of such resistance remains inconclusive, reinforces the need for vigilance and development of new insecticides (Section 9).
The emerging spread of pfhrp2 deletions means that the most widely used malaria diagnostic test is no longer reliable in most countries in the Horn of Africa, and this situation could spread rapidly to other countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
ACT resistance; it has not spread from the GMS to the rest of the world as was previously feared; nevertheless, it remains a threat to which WHO continues to pay attention.
11.2 THE ENABLING ENVIRONMENT AND THREATS TO THE MALARIA PROGRESS The unprecedented investment in malaria and the scale-up of interventions coincided with a period of considerable demographic and socioeconomic change in malaria endemic countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In sub-Saharan Africa, where over 90% of the malaria burden occurs, the population increased from 665 million in 2000 to 1.1 billion in 2019, and it is projected to rise to 1.5 billion by 2030 (154).
The proportion of this population that resides in urban areas increased from 31% in 2000 to 41% in 2019, and is projected to increase to 47% by 2030. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
GDP growth has averaged 4% since 2000, with several countries exceeding an average of 5% in this period (155), and the percentage of the population considered poor (i.e.
living on <US$ 1.90 a day at 2011 international prices) reducing from 60% in 2000 to 40% in 2018 (156).
The level of rural electrification rose from 11% to 32% of households, giving those households better economic opportunities, connectivity and access to information (157). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The 11 million mobile cellular subscriptions in 2000 increased dramatically to 537 million subscriptions in 2019 (158).
Major improvements in socioeconomic growth and development have also occurred in many malaria endemic countries outside sub-Saharan Africa (159).
These factors have no doubt contributed to general improvements in health and – both directly and in combination with the massive scale-up of malaria interventions – to the progress made against malaria since 2000. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Funding for malaria has plateaued since 2010 (Section 6) and, despite the welcome increase in Global Fund replenishment in 2019, per capita investments for populations at risk are unlikely to change greatly in the period 2020–2022.
The 2019 malaria funding of about US$ 3 billion is considerably below the US$ 5.6 billion estimated as being needed to achieve the GTS targets.
Despite impressive economic growth in malaria endemic countries, domestic funding for malaria has also stagnated over the past decade. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The plateauing of the burden of malaria at what is still a very high level is a wake-up call, drawing attention not only to the need to innovate against the vector and the parasite – by developing new tools, strategies and problem-solving approaches at the frontline of malaria control - but also to ensure that the global response evolves.
Sustained, strengthened and coordinated investments and actions are needed to build on earlier successes. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The efficacy of most of the current malaria prevention tools remains modest.
High levels of coverage and user Inadequate funding and inefficiencies in service delivery systems have resulted in some people failing to access and use malaria interventions.
In sub-Saharan Africa, the population sleeping under ITNs has remained similar to 2015 levels (and actually declined slightly between 2018 and 2019), with important inequities in several countries (Section 7.1). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Nearly 30% of children with fever are still not receiving care and less than half of those who seek care are not diagnosed using a parasitological test (Section 7.5).
A third of these children use private health facilities (Section 7), with households incurring expenses they can barely afford. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This draws further attention to the importance of UHC and of ensuring that mechanisms exist to deliver interventions without creating financial hardship.107WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 11Key results, context and conclusionThe link between improving human development and reducing the burden of infectious diseases is strong (160). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It is anticipated that as the world strives for a future without malaria, human development, in all its facets, will be one of the biggest drivers for this change (113).
At the same time, reducing the burden of malaria through prevention and treatment is likely to contribute to accelerated development.
Currently, however, more than 80% of the burden of malaria is concentrated in countries with low human development indices (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
11.1), assessed using dimensions of health, education and standard of living indicators (159), impairing the capacity and resilience of communities to respond to the burden of malaria.
About 90% of the burden of malaria occurs in countries where health expenditure as a percentage of GDP is less than 7%, and 75% of the burden is in countries where health expenditure is less than 5% of GDP (Fig.
11.2). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
11.2).
In these countries, more than 70% of funding for malaria is from external sources, mainly from the Global Fund and PMI (Section 6).
Among moderate to high transmission countries in sub-Saharan Africa, progress towards the target of 15% expenditure on health as a percentage of GDP by 2015 committed to by countries under the Abuja Declaration (1) remains elusive, with no country achieving it by 2017 (161).FIG.
11.1.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
11.2.Distribution of malaria cases in 2019 by human development index in 2018 Sources: WHO estimates, UNDP.Distribution of malaria cases in 2019 by current health expenditure as a percentage of GDP in 2017 Sources: WHO estimates, World Bank.100806040200sesacairaamlllabogfoegatnecreP<1%Very high1%High83%16%75%sesacairaamlllabogfoegatnecreP10080604020015%6%3%1%MediumLow≤5%>5% to 7%>7% to 9%>9% to 12%>12% to <15%0%≥15%UNDP: United Nations Development Programme; WHO: World Health Organization.GDP: gross domestic product; WHO: World Health Organization.Human development index, 2018Health expenditure (% of GDP), 2017108109WORLD MALARIA REPORT 2020 11Key results, context and conclusionThere are no reliable data measuring the status of health system governance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Fig.
11.3 presents the distribution of burden by level of general governance effectiveness, as analysed by the World Bank (162).
The index of governance effectiveness reflects respondent perceptions of the quality of public services, the quality of the civil service and its degree of independence from political pressures, the quality of policy formulation and implementation, and the credibility of the government’s commitment to policies. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Information on governance effectiveness for malaria endemic countries was extracted and countries were grouped into qualitative categories by government effectiveness as very low, low, moderate or high (Fig.
11.3).
About 77% of all malaria case burden is accounted for by countries with very low or low governance effectiveness.An analysis of the UHC service coverage index by country was undertaken by WHO for the period 2000–2017 (163). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This index was computed using information on 16 tracer indicators across four service coverage categories: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; and service capacity and access, and health security (164).
The burden of malaria and access to malaria interventions were also included in the composite index of effective service coverage. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The potential circularity notwithstanding, there is a clear pattern in the relationship between the UHC service coverage index and malaria burden (Fig.
11.4).
About 90% of the burden of malaria globally in 2019 was concentrated in countries that were classified as having a low UHC service coverage index (i.e.
<50).
FIG.
11.3.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
11.4.Distribution of malaria cases in 2019 by category of governance effectiveness in 2019 Sources: WHO estimates, World Bank.Distribution of malaria cases in 2019 by category of UHC service coverage index in 2017 Sources: WHO estimates, World Bank.sesacairaamlllabogfoegatnecreP10080604020055%22%17%Very lowLowModerateCategory of governance effectiveness, 20196%HighsesacairaamlllabogfoegatnecreP10080604020074%16%9%0%<4040–4950–5960–69UHC service coverage index, 20170%70–790%≥80WHO: World Health Organization.UHC: universal health coverage; WHO: World Health Organization.110111WORLD MALARIA REPORT 2020 11Key results, context and conclusionReliable health information is critical for developing sound strategic and operational plans, efficiently and equitably targeting resources and reliably measuring the impact of interventions (Section 3, Section 5). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Considerable improvements have been made in recent years, building on the introduction of parasitological diagnosis, which have improved the value of the data on malaria cases, and the use of digital solutions (e.g.
DHIS2), which in turn have improved data transmission, validation and analysis.
In many moderate to high burden countries, especially in sub-Saharan Africa, the available routine data are increasing in volume, but there are still considerable issues with data quality. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Consequently, for 30 countries in this region – which account for over 85% of the burden of malaria cases for this report – malaria case totals are computed using a method that derives case incidence from intermittent community parasite prevalence data (Section 3, Annex 1).
Mortality estimation also relies on verbal autopsy data to define causes of death; however, such data have been shown to be unreliable in identifying malaria deaths (165). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Facility-level electronic data entry is non-existent in most of the countries in sub-Saharan Africa, making data transmission and aggregation labour intensive, and increasing the likelihood of transcription errors and significant delays.
These weaknesses have been most starkly demonstrated by the difficulties in tracking service disruptions during the COVID-19 pandemic (Section 10). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Over the past 2 decades, malaria endemic countries have also had to deal with numerous complex emergencies – both natural and human made – undermining progress in these countries and resulting in a heavy toll on already fragile health and livelihoods. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
As recently as 2018–2020, many high burden malaria endemic countries have been afflicted with major storms or flooding, including, for example, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, Somalia, South Sudan, Sudan, Uganda and the United Republic of Tanzania (166-168). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Many countries are also dealing with local active conflicts (170) that limit the population’s access to care, and the ability of government and stakeholders to reach people.
In addition, frequent outbreaks and epidemics of non-malaria diseases in malaria endemic settings have resulted in major disruptions to malaria services (Section 10). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Despite their frequency and impact, these emergencies are unpredictable; in fact, they are missing entirely from quantitative global projections of the future trajectory of malaria (113, 115).
Between 2007 and 2018, almost US$ 7.3 billion was invested in basic research and product development for malaria, rising from about US$ 500 million in 2007 to slightly over US$ 650 million in 2018 (Section 6).
A lot of knowledge has been generated and many tools are in the pipeline. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
However, progress against malaria in the past 2 decades has been delivered by the continued dependence of countries on a combination of several imperfect tools delivered to communities through relatively expensive mechanisms (Section 7), resulting in persistent gaps in coverage.
Many of the tools currently in use were developed in the 1980s and 1990s. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
There have been progressive improvements, such as new ITNs/LLINs, new ACTs, and new formulations of existing ACTs and the advent of RDTs (an important innovation that enhances case management), the targeted use of ACTs the value of routine malaria case data.
The next major innovation may be a malaria vaccine, introduced as part of routine control efforts.
Pilot implementation of RTS,s/AS01 in three African countries started in 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In late 2021, WHO is expected to review evaluation data from the pilots together with the results of several studies conducted since 2015, and consider the advisability of broader use of this vaccine.
This would open a new paradigm in the approach to malaria control.11.3 CONSEQUENCES OF THE COVID‑19 PANDEMICCOVID-19 has exposed the fragility of today’s society and systems, shaken the global economy and begun to reverse the progress made in reducing poverty and fighting disease (171). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It is estimated that COVID-19 will push about 100 million people into extreme poverty in 2020 and will have a prolonged economic legacy (172).
At the time of writing, almost 50 million cases of COVID-19 have been reported to WHO, and more than 1.2 million people have lost their lives.
millions more are likely to have died due to disruption of essential health services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Health sectors across the world are facing a triple challenge: minimizing the immediate health impact of COVID-19, reducing disruption to other essential services and managing the health of their nation while reorienting their economies for recovery.
The limited fiscal space in many parts of sub-Saharan Africa has compromised spending on COVID-19 and continues to threaten other health priorities. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Early lockdown measures in many malaria endemic countries may have protected people from COVID-19, but they have also affected people’s access to health care and other services.
On the demand side, fewer patients are presenting to outpatient care (Section 10), fearing the risk of becoming infected with COVID-19, and hindered by lockdowns and lack of transport. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
On the supply side, elective care has frequently been cancelled, and commodity supply chains both within and beyond malaria endemic countries have been disrupted.
COVID-19 highlighted the severe shortages in the health workforce in LMICs, compromising clinical and social care and public health services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Health worker redeployment, fear of returning to work without PPE, sickness and death have further hampered service delivery (173).malaria endemic countries surveyed have also reported disruptions to malaria diagnosis and treatment (Section 10).
Although disrupted or delayed, many of the campaigns for ITNs and SMC were conducted safely. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
However, the analysis suggests that even if malaria prevention campaigns are completed in 2020 as planned, disruptions to access to effective antimalarial treatment could lead to considerable loss of life (Section 10).
The lack of infection prevention in facilities, including PPE, has had dire personal and public health consequences. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A disproportionate number of health workers have been infected with COVID-19, compromising the capacity to deliver essential services, putting patients at risk of COVID-19 and deterring people from seeking care. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Based on reports from key informants, the most frequently disrupted areas included routine immunization-outreach services (70%) and facility-based services (61%), non-communicable diseases diagnosis and treatment (69%), family planning and contraception (68%), treatment for mental health disorders (61%), and cancer diagnosis and treatment (55%) (152).
Thirty-seven (58%) of 64 The pandemic is clearly a global crisis that requires a concerted global response. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The sheer scale of the pandemic and the broader disruptions it has caused requires strong leadership and citizenship to chart a new way forward.
In an interconnected world, this pandemic has highlighted the critical importance of global solidarity in addressing the divisions, fragilities and inequities that COVID-19 and other infectious diseases thrive upon. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The ACT Accelerator (174) is a good example of the collective resolve necessary to rapidly develop quality assured vaccines, diagnostics and therapeutics, and to allocate them fairly.
Building on the GTS principles, these positive lessons from COVID-19 need to be extended to the malaria response.11.4 BUILDING A MORE PROSPEROUS FUTUREThe challenge of getting back on track during such difficult times is daunting, but there are reasons to be hopeful. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Over the past 2 decades the malaria community has shown what it can do when faced with adversity. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Looking forward, as we learn from COVID-19 and the early progress on HBHI, the principles outlined in the GTS become even more relevant for the challenges we are facing today.11.4.1 Country ownership and leadership, with involvement and participation of communities, are essential to accelerating progress through a multisectoral approachThe major public health challenges, including malaria, require a whole of government, whole of society approach. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Trusted, accountable national political leadership is essential, using the best knowledge and science to galvanize the many actors around a common narrative and unified response.
Their political commitment will need to translate into resources and actions to ensure that all those in need have access to the appropriate mix of interventions for malaria prevention and quality health care, without financial hardship. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
As with other health priorities, this relies upon the inclusion and participation of many stakeholders, including the most vulnerable communities, women and children.
Empowered and incentivized individuals are at the heart of primary health care, as people and their communities are advocates for policies that promote and protect health and well-being, are co-developers of health and social services, and act as self-carers and caregivers to others (114). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Subsets and Splits