As countries begin to see the benefits of sustained malaria intervention, they worry that they may be punished by donor agencies for their success. For example, The Tanzania Daily News reports that, “HEALTH officials in Zanzibar have said that the Islands are likely to experience problems in the fight against Malaria should major donors, including Global Fund and the United States government pull out from financing the project.”
Zanzibar is nearing pre-elimintion malaria transmission levels but is dependent on donor funding to maintain progress. The Daily News specifies that, “The US through itsPresident’s Malaria Initiatives (PMI) remains the leading financier with 56 per cent of the funds received for the malaria campaign. Global Fund is 40 per cent, WHO and UNICEF two per cent; other donors 1.97 per cent; and Zanzibar government is 0.03 per cent.”
Health officials did clarify the actual situation by saying that, “We are happy that PMI has not shown any indication to pull out, but we must prepare ourselves and look for alternative financiers should the US stop supporting Malaria programme.” A look at the latest grant progress report for Zanzibar at the Global Fund website had only a report from August 2012 for Round 8 Malaria Grant that was made near the end of Phase 1 of the grant.
It is not clear if Phase 2 of the Global Fund grant has been or will be funded, but we know that the GFATM has been going through financial difficulties and changes. This is likely why Zanzibar health managers are worried. The last grant rating was files back in 2011 and gave the program a ‘B2′ rating which is cause for caution and possibly hints at reasons why Phase 2 is in limbo.
PMI reports that donor support and Zanzibari leadership, “has resulted in a dramatic decrease in malaria prevalence in Zanzibar. However, persistence of malaria transmission in surrounding areas (Tanzania mainland and Kenya) leaves the island vulnerable to sudden outbreaks and the re-establishment of ongoing, perennial malaria transmission.” Even though Zanzibar is an island, it is still vulnerable, and any withdrawal of support would negate and reverse gains made. For example, PMI explains that Zanzibar is a place where “Malaria Early Epidemic Detection System (MEEDS) … an innovative mHealth system” is being tested.
Pre-elimination not only requires sustaining existing interventions, but also implementing new ones like MEEDS in order to maintain necessary surveillance that will ultimately document whether malaria elimination has succeeded. As PMI notes, “MEEDS and Coconut Surveillance are helping Zanzibar to identify and treat many otherwise undiagnosed malaria cases, identifying hot spots and transmission patterns, and responding rapidly to new outbreaks. These mHealth applications are helping Zanzibar to sustain the remarkable gains it has made against this dangerous and debilitating disease.”
Also, “maintaining and continuing to reduce malaria transmission will require ongoing education for both health care providers and residents to reinforce the importance of using preventive measures,” as the public and health workers perceive the drop in prevalence according to Bauch and colleagues. Malaria prevalence in Zanzibar has been less that 1% for over 6 years, and we need to continue to reduce it.
Interventions in the final phases of malaria elimination may not be as dramatic or visible as distributing millions of insecticide treated bednets, but they are just as essential. We need to maintain support in all endemic countries until we see malaria elimination through to its conclusion. Otherwise years of intervention will be wasted, and new lives will be lost.