President’s Malaria Initiative Strategy 2015–2020

I. Executive Summary

The fight against malaria has yielded dramatic progress over the last 10–15 years. The World Health Organization (WHO) estimates that the scale-up of malaria control interventions between 2001 and 2013 resulted in an estimated 4.3 million fewer malaria deaths. These impressive results – particularly in sub-Saharan Africa – are due to a massive scale-up of malaria prevention and case management measures resulting from the combined efforts of national malaria control programs (NMCPs), a broad range of partners, and the launch of three major initiatives: the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002, The World Bank Malaria Booster Program in 2004, and the U.S. President’s Malaria Initiative (PMI) in 2005. In December 2010, the UK Department for International Development committed to increase its support for malaria control by up to £500 million. While the increased level of donor funding for malaria control during the past decade was unprecedented, it is still significantly below the estimated US$5.1 billion that is required annually to achieve global targets for malaria control and elimination.

The scale-up of malaria control measures and the resulting decline in malaria illnesses and deaths since 2000 has not been uniform throughout Africa. In some countries, further efforts to attain high coverage with malaria control interventions are needed before substantial reductions in malaria burden can be expected. In contrast, other countries have progressed to a point where malaria is no longer a leading public health problem. These successes have prompted shifts in the goals and targets of many partners in the global malaria community, including the Bill & Melinda Gates Foundation, the Roll Back Malaria (RBM) Partnership, and WHO. While the progress to date is historic, the continued control and ultimate elimination of malaria remains fraught with serious challenges, including resistance to the artemisinin family of drugs, wide availability of substandard and counterfeit malaria treatments, resistance to key insecticides, inadequate disease surveillance systems, and waning country and donor attention as malaria burden drops.

When it was launched in 2005, the goal of PMI was to reduce malaria-related mortality by 50 percent across 15 high-burden countries in sub-Saharan Africa through a rapid scale-up of four proven and highly effective malaria prevention and treatment measures: insecticide-treated mosquito nets (ITNs); indoor residual spraying (IRS); accurate diagnosis and prompt treatment with artemisininbased combination therapies (ACTs); and intermittent preventive treatment of pregnant women (IPTp).With the passage of the Tom Lantos and Henry J. Hyde Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S. Government Malaria Strategy for 2009–2014.This strategy included a long-term vision for malaria control in which sustained high coverage with malaria prevention and treatment interventions would progressively lead to malaria-free zones in Africa, with the ultimate goal of worldwide malaria eradication by 2040–2050. Consistent with this strategy and the increase in annual appropriations supporting PMI, four new subSaharan African countries and one regional program in the Greater Mekong Subregion of Southeast Asia were added in 2011.The contributions of PMI, together with those of other partners, have led to dramatic improvements in the coverage of malaria control interventions in PMI-supported countries, and all 15 original countries have documented substantial declines in all-cause mortality rates among children less than five years of age.

This updated President’s Malaria Initiative Strategy (2015– 2020) takes into account the progress over the past decade and the new challenges that have arisen, setting forth a vision, goal, objectives, and strategic approach for PMI through 2020, while reaffirming the longer-term goal of worldwide malaria eradication. Malaria prevention and control remains a major U.S. foreign assistance objective, and this strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty. It is also in line with the goals articulated in the draft RBM Partnership’s second Global Malaria Action Plan and WHO’s draft Global Technical Strategy.

The U.S. Government shares the long-term vision of affected countries and global partners of a world without malaria.This vision will require sustained, long-term efforts to drive down malaria transmission and reduce malaria deaths and illnesses, leading to country-by-country elimination and eventual eradication by 2040–2050.The U.S. Government’s goal is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, toward the long-term goal of elimination. Building upon the progress to date in PMI-supported countries, PMI will work with NMCPs and partners to accomplish the following objectives by 2020:

1. Reduce malaria mortality by one-third from 2015 levels in PMI-supported countries, achieving a greater than 80 percent reduction from PMI’s original 2000 baseline levels.

2. Reduce malaria morbidity in PMI-supported countries by 40 percent from 2015 levels.

3. Assist at least five PMI-supported countries to meet the WHO criteria for national or sub-national preelimination.

To achieve these objectives, PMI will take a strategic approach which emphasizes the following five areas:

1. Achieving and sustaining scale of proven interventions

2. Adapting to changing epidemiology and incorporating new tools

3. Improving countries’ capacity to collect and use information

4. Mitigating risk against the current malaria control gains

5. Building capacity and health systems.

These areas of focus are informed by PMI’s experiences to date, which include building on the successes that countries have achieved with the support of PMI and other partners, incorporating the lessons learned from implementation thus far, and addressing directly the ongoing and new challenges that could prevent further progress toward malaria control and elimination.