Core strategies for elimination
1. Maintaining high levels of prevention coverage reached through scale-up.
Ensuring clinical malaria infections are promptly diagnosed with quality laboratory methods (e.g., microscopy or rapid diagnostic tests and treated with the national standard antimalarial drug).
2. Implementing a set of locally-based strategies to proactively clear malaria infection in entire communities and establishing infection surveillance systems that will identify and contain remaining focal transmission.
3. Transitioning the national evaluation program to monitor infection transmission and establish the ability to document and hold infection transmission at zero.
Some countries that have successfully reduced malaria burden are implementing an innovative surveillance system designed to find and treat remaining malaria infections. This three-step approach helps countries implement robust malaria surveillance and reporting systems, find and treat all infections in identified malaria hotspots, and respond to potential outbreaks before they grow—with the ultimate goal of eliminating all malaria illnesses and deaths.
- Rapid reporting. Community health workers equipped with data-enabled cell phones report weekly on malaria burden. Data is sent to a centralized server, where it is used to inform program planning and improve targeting of resources, allowing ministries of health to respond to gaps in coverage in real time. The data also flows back to community health workers themselves so that they are able to see their progress and gaps and view results from across the district. These frequent flows of robust data help set a baseline for monitoring the disease and allow ministries of health to effectively allocate resources.
- Mass test and treat. During the dry season, groups of community health workers visit areas identified as malaria hotspots to test all residents for malaria and treat those carrying malaria parasites in their bloodstream. This approach is especially effective, as it detects asymptomatic carriers of the disease and clears pockets of infection in communities. These dry-season sweeps are repeated as needed, to bring transmission as close to zero as possible before the rainy transmission season begins again.
- Active surveillance. Once malaria burden is low, an active surveillance system is put into place. Any person who tests positive for malaria, and has not recently traveled to a malaria-endemic area, is followed back to their household by a team of community health workers. Everyone in their household is then tested for malaria, as well as residents in the immediate surrounding area, to ensure that any local transmission of the disease is eliminated.