Malaria Elimination in Crisis Zones: A Policy Perspective
T20 policy brief on malaria and disaster management
Malaria, a preventable and treatable disease, is a formidable public health challenge particularly in regions affected by conflict and disaster. The complexities of providing healthcare in such environments have been significantly alleviated by the essential work of civil society organizations (CSOs). In the vanguard of this fight against malaria is C20 India 2023 (Civil20), a part of the official G20 Engagement Groups.
The Group of Twenty (G20), an international forum for governments and central bank governors, has recognized the importance of engagement with diverse groups. The C20, an engagement group of the G20, provides a platform for CSOs globally, enabling them to voice the concerns and aspirations of people to the world leaders of the G20. C20 India 2023 represents the unique dynamism of Indian civil society, steeped in a tradition of self-reliance, sustainability, and public participation.
“India has made remarkable progress towards malaria elimination in recent years and has been appreciated at the global level – among the 11 countries that are part of the World Health Organization's 'High Burden to High Impact' initiative. However, it is crucial to for India to sustain the momentum towards malaria elimination, especially for the hard-to-reach areas.”
In this context, one global issue that stands out and demands urgent attention is malaria. Despite the significant progress made in the last two decades worldwide, malaria remains endemic in 84 countries. It disproportionately impacts vulnerable populations, who often reside in rural and remote areas. These communities suffer from the effects of weak health systems, the result of poor infrastructure, limited access to formal healthcare, and socioeconomic barriers.
To address the challenges and strengthen the fight against malaria, the Asia Pacific Leaders Malaria Alliance (APLMA) recently engaged with the Think20 (T20) in India, involving think tanks and high-level experts to discuss policy issues relevant to the G20. Together with the Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, we published a policy brief towards reducing the disease burden and eliminating malaria in fragile, conflict-affected and disaster-prone areas.
WHO is responding to the health crisis in Afghanistan. Credit: WHO
The WHO estimates that 268 million people were impacted by humanitarian crises in 2021, compared to 301 million in 2020. Malaria elimination in fragile and conflict-affected states presents a unique set of challenges. Service delivery of malaria prevention and treatment interventions can be severely disrupted due to limited resources, poor infrastructure, and ongoing conflicts. Additionally, disaster management policies in these areas often focus on reacting to crises rather than proactively responding to them.
“The main challenge with eliminating malaria lies in maintaining the sustainability of interventions, particularly in unstable regions affected by conflict. Here, short-term solutions may risk progress. We urge the G20 to use its influence to boost funding for malaria elimination programmes and improve healthcare access for marginalized groups like refugees and the internally displaced. We must not forget that the only way to achieve a malaria-free world is by achieving it together - We cannot leave anyone behind!”
Increase funding for malaria elimination efforts
G20 countries can increase funding for malaria elimination efforts in fragile and conflict-affected states by using their collective economic and political influence to promote increased funding and resources for malaria control programmes. For example, supporting the Global Fund, as well as encouraging member countries to provide financial incentives to the private sector through tax breaks and more. This can also link back to supporting public-private partnerships that promote developing and distributing innovative malaria control and elimination tools.
Tailored malaria response
Essentially, we must acknowledge and recognize how factors like poverty, lack of healthcare, and poor living conditions can put the communities at higher risk of getting affected with malaria. One of the ways is to use the Differential Vulnerability Framework (DVF), which tells us how different vulnerable groups, including women, are affected differently by health issues, depending on their living situation, wealth, and environment. One of the key success stories include the MENTOR initiative, which was founded in 2022 by Richard Allan. This group trained local community health workers to provide essential medical support, especially for malaria and other common diseases. When displaced due to unexpected conflicts, these health workers even move with their communities. Currently, the initiative is active in countries including the Central African Republic, Mozambique, Angola, Syria, and Venezuela.
Knowledge-sharing and partnerships
We are also calling on the G20 to urgently prioritise capacity-building and knowledge-sharing initiatives, demonstrate successful interventions, and leverage the G20 platform to disseminate crucial information. Coordination among partners can be improved through joint task forces, resource pooling, and centralised data sharing. Furthermore, integrating succinct monitoring and evaluation is crucial for assessing program effectiveness.
Finally, the G20 platform should also support the development of partnerships with non-governmental organisations, academic institutions, and the private sector to leverage expertise, resources, and innovation towards malaria elimination efforts. One of the ways to achieve this is by utilising the ‘Health in All Policies (HiAP)’ framework, which addresses the social determinants of health that underlie malaria transmission and address the complex challenges faced by health systems in fragile and conflict-affected regions.
“An increased investment in collaboration would expand the capacity of each country to prevent, detect and respond to endemic diseases. With strong partnerships, reinforced by increased public and private sector funding and cooperation, we can achieve malaria elimination and strengthen health systems."
A cohesive, adaptive, and well-resourced approach involving various stakeholders is needed to strengthen and empower communities to become resilient against future health emergencies. Our recommendations in these briefs will ultimately be presented to G20 working groups, ministerial meetings, and leaders’ summits to help them implement tangible concrete policy actions, with the ultimate goal of achieving malaria elimination by 2030.