Part III: Regional Strategies
1. Introduction to Regional Strategies
Malaria varies greatly around the world in the level of intensity, in the vectors that transmit it and in the species causing the disease. In order for the global strategy to be relevant for countries around the world, it must be applicable to different settings. In this context, the purpose of the Regional Strategies chapters is to translate the global strategy into regionally-specific approaches for controlling and eliminating malaria, taking into account the differences between regions.
Figure III.1 shows how malaria-endemic countries have been grouped into four regions: Africa, the Americas, Asia-Pacific, and Middle East and Eurasia. This categorization aims to provide high-level clarity. Naturally, countries within the same region will differ substantially in important dimensions and will need to tailor their malaria control strategies beyond the recommendations offered in this section.
Figure III.1: Malaria-endemic countries divided into four regions
These regions differ in many ways: the size of the populations at risk, the disease burden in terms of deaths and cases, the relative mix of malaria species and the level of funds available to fight the disease. Africa is distinguished by having almost 100% of malaria caused by P. falciparum, a high number of cases and deaths per population at risk, the most external support and the lowest governmental spending of any region. On the other hand, the Americas and Middle East and Eurasia are dominated by P. vivax, have very few cases and deaths, and a high degree of governmental spending on malaria. Asia-Pacific falls between Africa and the other two regions. It has the largest populations at risk, largely mixed infections with P. vivax and P. falciparum, moderate number of cases and deaths, and two thirds of its funding from governments. These differences play an important role in determining what the strategy should be for each region.
Thirty-five countries are responsible for 98% of the total malaria deaths world-wide. They also contribute to ~96% of the total number of malaria cases. To achieve the 2010 and 2015 targets, support for these countries is essential:
- 30 countries in Africa: Nigeria, Democratic Republic of Congo, Uganda, Ethiopia, Tanzania, Sudan, Niger, Kenya, Burkina Faso, Ghana, Mali, Cameroon, Angola, Côte d'Ivoire, Mozambique, Chad, Guinea, Zambia, Malawi, Benin, Senegal, Sierra Leone, Burundi, Togo, Liberia, Rwanda, Congo, Central African Republic, Somalia, and Guinea-Bissau
- 5 countries in Asia-Pacific: India, Myanmar, Bangladesh, Indonesia, and Papua New Guinea
However, all countries are important in the global fight against malaria. The regional chapters address the needs of all malaria-endemic countries in each region, not just the countries with high contributions to global deaths. Table III.1 summarizes the funding required by region to meet the needs of all countries. As the burden decreases overtime, the distinction between high and low burden countries will become less important and regional and global cooperation to sustain control will increasingly become the focus.
Table III.1: Current spend and funding required by region
|Cost (US$ millions)||Spend||Estimated funding required|
|2007||GAP||2009||2010||2011 - 20 avg|
|Middle East and Eurasia||92||96||188||226||147|
|Total control & elimination cost||1,109||4,226||5,335||6,180||5,129|
Note: The 2007 estimates include government and international donor spend. They do not include household spend.
Source(s): GMAP costing model, WHO, the Global Fund, the World Bank and the President's Malaria Initiative (PMI)
Each regional chapter follows a similar format. The upfront section, Introduction to Malaria in the Region, introduces the epidemiology and burden of malaria and reviews the current response against malaria (policies, number of interventions delivered, etc). The second section, Recommended Regional Approach to Control and Eliminate Malaria, translates the RBM targets into concrete regional targets, estimates the number of interventions needed, highlights region-specific challenges, outlines the strategic priorities for the region, and the type of support needed to achieve the strategy. Finally, each chapter will conclude by providing an estimate of funding required by intervention over time.