Cross-border transmission of malaria poses a significant challenge to successful elimination of the disease. To address this challenge, country programs and international donors are increasingly focusing on regional approaches to malaria elimination. Regional initiatives (RIs) are multi-country and multi-sector partnerships with governmental support that work towards common goals. RIs often provide unique solutions to challenges that countries may struggle to address on their own. Despite increasing attention towards establishing RIs, there is limited information and guidance on the key activities and effective organizational components.
In a recent PLOS Medicine policy forum Regional initiatives for malaria elimination: Building and maintaining partnerships(link is external), Malaria Elimination Initiative (MEI) researchers provide a systematic review of ten existing regional malaria initiatives. In this review, researchers at the MEI describe the need for RIs, and identify common characteristics, key activities, and remaining challenges.
Challenges that regional initiatives aim to address
Regional elimination towards eventual global eradication presents new challenges for malaria control programs. These include:
- region-specific technical problems in the final stages of elimination;
- movement of people and parasites across international borders with the potential to impact both national health systems and human security;
- decreasing prioritization of malaria within ministries of health due to low caseloads and competing disease priorities (e.g. dengue and hypertension) leading to limited financing to support malaria elimination; and
- increasingly hidden malaria burden, generally confined to remote regions and marginalized populations.
Common characteristics, activities and challenges
In the review, the MEI identifies key organizational elements that are often seen in the documented regional initiatives to date: a strategic coordination body, technical forums, mechanisms to distribute financing, a high-level political council, and a regional champion or envoy. The MEI also suggests that RIs are well-positioned to build a region-specific evidence base, leverage expertise and resources, shift commodities or pool procurement, develop data-sharing systems, mobilize resources, promote high-level accountability, and strengthen advocacy and resource mobilization. All of the RIs reviewed carry out a majority of these activities for their member states.
The MEI also noted challenges facing RIs including differing priorities and engagement amongst members; difficulties in data sharing across data platforms; and inflexible grant-making procedures for RIs. Finally a pervasive challenge is the limited external review and documentation for many RIs. In order to strengthen evidence for regional approaches to elimination, the MEI highlights that monitoring and evaluating the impact of regional initiatives must be improved. A suitable set of indicators to better evaluate the impact of RIs is also needed.
As we see a continued trend towards financing regional and multi-country approaches malaria elimination, donors should consider modifying and streamlining proposal and grant management processes that were previously created to disburse national and bilateral grants. RIs have an important role to play in the malaria elimination landscape but require careful design, implementation, and evaluation to ensure alignment with expected outcomes and impact.