Zanzibar - The prevalence rate of malaria in Zanzibar is currently below one percent--the lowest in Tanzania and in the Eastern and Central Africa. The result is one the best news from the review conducted in September 2022 by different stakeholders, including Government and development partners to document implementation of the Zanzibar Malaria Strategic Plan (MSP).

The review examined the performance of the Zanzibar Malaria Elimination Programme (ZAMEP) and recommended improvements for the next plan. Over five years, Zanzibar’s Malaria elimination strategic plan implemented seven strategic objectives. WHO has been supporting the Zanzibar to implement those objectives and, participated in the review.

Speaking at a retreat of Programme Management Officers in Zanzibar on 19th October, the Director of Preventive Services, Dr. Salim Slim commended the contribution made by development partners in the fight against malaria in Zanzibar.

“We received technical and financial support from WHO, Global Fund, and many other organizations that supported the implementation of our plans to eliminate malaria. We count on this support as we commit to sustaining the gains and step elimination of malaria in Zanzibar,” said Dr. Slim.

The objectives, implemented for five years from 2017, include ensuring quality assured diagnosis and appropriate case management in all health facilities and at the community level to 100%; increasing appropriate vector control measures to the population at risk of malaria to 100%; reinforcing malaria surveillance for malaria elimination to actively investigate and classify all confirmed cases from 0% of 2017 to 100%.

Other objectives were initiating vector surveillance in malaria prone areas, improving advocacy, behaviour, social communication and mobilization to the general population on malaria elimination intervention by 90% in 2023, appropriate operational research is undertaken to evaluate and optimize malaria and strengthening coordination structures for malaria elimination at different operational levels.

The results of the review, published, in an official report show that the objectives of the were reached, therefore taking Zanzibar very close to elimination of malaria. The program has managed to ensure quality diagnosis and appropriate case management in all health facilities and at the community level was achieved. With no stock out of test kits since 2020, all malaria suspects got rapid diagnostic test (RDT) and malaria microscopy before treatment.

“The evidence of an ever-decreasing rate of malaria in Zanzibar proves that with collaboration and efforts at community, facility and policy level, we can achieve goals that may seem elusive,” said Dr. Zabulon Yoti, Acting WHO Country Representative in Tanzania.

With government funding the program procured and distributed anti-malarials to all public health facilities. Subsequently, district pharmacist’s redistribution medicines based on demand prevented over-stocking and/or expiration of anti-malarials in facilities.

Vector control and surveillance, which are critical in the fight against malaria also registered success. ZAMEP with support from partners successfully sprayed 95% of targeted structures with insecticides and net distribution reached rate of one insecticide treated net for every 1.8 people, only a fraction short of the ideal one net per every two people.  

“ZAMEP has an efficient vector surveillance system and a good molecular laboratory infrastructure required for the successful implementation of interventions in the elimination phase,” said, Dr. Jovin Kitau, a WHO Malaria Control Technical officer, who participated in the review.

The review also found that there is a strong system for malaria reporting through national health information. Case investigation improved from 73% in (2017/18) to 92% (2020/21), and the foci investigation quickly elevated from 0% in 2018/19 to 99% in 2021/2022.

In the community, the review found community members with sufficient knowledge of malaria elimination interventions because of consistent exposure messages through mass media and word of mouth from community health volunteers.

The program commissioned and supported the conduct of operational research to guide the effective implementation of activities. Specific studies were carried out to establish the sensitivity of rapid test kits to detect infections, and the use of drones for larviciding, among others.

Another important finding from the review was a 3.7 folds increase in the allocation to health in the country budget from 31.7 million USD in 2017/18 to 117.3 million USD in 2022/23. The aggregate total allocation to health has increased from 6.7% in 2018/19 to 11.0% in 2022/23 of the total government budget.

Whereas these achievements put Zanzibar very close to coveted stage of elimination malaria, there ZAMEP faced consistent and emerging challenges. One of the emerging challenge is increase of mosquitoes’ resistance to available insecticides, people more often getting bitten by mosquitoes outdoors than indoors and some mosquito varieties’ adaptations to available control measures.

Despite brilliant rate of testing before treatment using rapid tests, malaria microscopy services are still limited and hampered in several facilities because of either non-availability of microscopes or limited skills to undertake microscopic services.

The review recorded noted the difficulties in obtaining data on government contribution towards the malaria program but acknowledges significant contributions through counterpart funding, salaries of health workers, and other indirect contributions.