Why you should care

Because this country’s initiative could help save millions of lives.

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In this limited series, OZY looks at leading-edge ideas from the fields of technology, health care and education that are emerging from different countries within Africa.

In a remote village of Swaziland, at the end of a long dirt path, a group of medical workers goes house to house taking samples of people’s blood for testing on the spot. It doesn’t look like much, but those results could hold the key to ridding the world of one of this region’s deadliest diseases: malaria.

Africa’s smallest kingdom is en route to eliminate malaria by early 2017, according to Swaziland’s National Malaria Control Program, which would make it the first mainland country in sub-Saharan Africa to get rid of the potentially deadly parasitic disease altogether. Thanks to the use of innovative techniques like preemptive testing and real-time case mapping, Swaziland’s malaria cases decreased by 99 percent between 2000 and 2014; the disease now impacts around 600 people per season.

Swaziland’s progress … might help with the local battle against AIDS.

Other countries have also been making malaria-free strides in recent years, of course, including Botswana and South Africa. Yet mountainous Swaziland has several advantages. The country has operated an effective vector-control strategy, mainly using indoor residual spraying, ensuring that coverage is maintained at high levels during malaria season. And what distinguishes Swaziland the most is its surveillance mechanisms. These include “active case detection,” which sends officers to the site of every new case to test anyone living in the vicinity of patient zero — crucial because communities where malaria thrives tend to be isolated, and inhabitants often develop resistance, meaning they have few symptoms and are unlikely to go to a hospital.

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This has been made possible through the introduction of innovative technologies such as the real-time mapping of cases, ad hoc intervention teams and quicker tests than before. Saleemah Abdul-Ghafur, a consultant for Malaria No More, says now others can add these tools to “the arsenal of effective weaponry against both the malaria parasite and the mosquito.” It also helps that Swaziland is smaller than the size of New Jersey and boasts just 1.3 million inhabitants, with a geography that makes it so that half of the nation is too high in altitude for the mosquitoes to survive, especially during dry season.

The other key to success has been “visionary leadership,” says Roland Gosling, director of the Global Health Group’s Malaria Elimination Initiative at the University of California, San Francisco. “Swaziland is determined to do anything to eliminate the problem,” he adds. Indeed, Simon Kunene, the manager of Swaziland’s National Malaria Control Program, has pioneered a very flexible approach based on allotting funds in almost real time to solutions that show the best results on the ground, instead of simply following broad World Health Organization recommendations. Recently, the Ministry of Health released a new national malaria-elimination strategic plan to boost elimination efforts through 2020.

Collecting enough funds to sustain all these programs may prove to be a challenge, though. Swaziland’s hands-on approach is expensive, and while so far the country has managed to attract large donations, the government will need to take over when the last case is detected. And this will be a dangerous point, warns Gosling, because resurgence is a real concern — and Swaziland could easily find itself like Sri Lanka, which got down to seven cases a year but then stopped financing prevention programs and saw 20,000 malaria deaths within just five years.

Even so, the biggest roadblock standing in the way of Swaziland’s goal is its neighbor — and major malaria exporter — Mozambique. The disease knows no borders, so, last year, Swaziland contributed to a large-scale fumigation in Mozambique’s south, near their shared border, to reduce the importation of the disease. Successful long-term partnerships will be key if Swaziland wants to stop malaria for good. That’s why its minister of health is now the chair of Elimination 8, a regional initiative aimed at eradicating malaria in Botswana, Namibia, South Africa and Swaziland by 2020. If successful, it could pave the way for other countries such as Angola, Mozambique, Zambia and Zimbabwe.

To be sure, Swaziland’s success is part of a worldwide trend. Since 2000, malaria mortality rates globally have dropped by 60 percent, to about 438,000 cases in 2015. Increased prevention and control measures have certainly helped, though sub-Saharan Africa still carries the heaviest burden, with around 90 percent of all malaria cases as well as related deaths, according to the WHO.

Success in Swaziland could create a new kind of role model for sub-Saharan Africa in health care more broadly. Gosling, for one, says the progress — especially around the proactive testing of isolated groups — might help with the local battle against AIDS. For now, though, this little-known landlocked nation is proving that when it comes to fighting the world’s deadliest disease, size doesn’t matter.

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