RBM Progress & Impact Series
South Africa has been able to roll out and sustain effective malaria control interventions for more than 70 years, largely through domestic funding. After a major epidemic in 1999/2000, the country implemented evidence-based and practical policies that have successfully positioned it to eliminate the disease by 2018.
The country has a decentralized malaria control programme, with the national malaria programme at the National Department of Health (NDOH) defining policies and guidelines, and providing technical support to provinces. Activities occur at a provincial level, funded by a dedicated budget through the national treasury. Elimination interventions are focused on cross-border collaborations with Mozambique, Swaziland and Zimbabwe, integrated vector management, robust health promotion activities and a solid active surveillance programme.
The national budget for malaria control increased significantly between 2007 and 2008, reaching an average of US$ 25 million annually between 2009 and 2012.
South Africa enforced malaria control strategies and implemented critical interventions:
- Indoor residual spraying (IRS) coverage of targeted structures was 88% on average in malaria-endemic provinces between 2000 and 2012, with about 1.8 million structures sprayed in 2012/2013.
- Rapid diagnostic tests (RDTs) were rolled out nationwide in 2003 and artemisinin-based combination therapies (ACTs) introduced for uncomplicated case management subsequent to parasitologically confirmed diagnosis in KwaZulu-Natal in 2001, in Limpopo in 2004, and in Mpumalanga in 2006.
- Since 2000, all suspected malaria cases have been diagnosed using microscopy and/or RDTs. In 2011, 61% and 39% of malaria cases were respectively confirmed by microscopy and RDT.
- All positive cases are treated within 24 hours, and treatment is only prescribed once cases are confirmed (not presumptively).
- Training is a cornerstone of the malaria control programme: more than 7700 spray operators were trained between 2005 and 2012; an average of 500 doctors and nurses are trained each year in managing severe malaria; and regular training sessions in malaria case management are organized for health-care workers.
- South Africa was instrumental in initiating cross-border malaria initiatives, such as the Lubombo Spatial Development Initiative (LSDI) through the signing of a trilateral agreement with heads of state in Mozambique and Swaziland. These efforts led to further reductions in malaria morbidity and mortality in South Africa.