COSTA RICA: PLAN DE ELIMINACIÓN DE LA MALARIA 2015-2020,
MINISTERIO DE SALUD DE COSTA RICA (MINSA)
Costa Rica has achieved a 100% decrease in malaria cases since 2000, and reported zero authoctonus cases since 2013. The country is awarded the distinction of Malaria Champion 2016 in recognition of its sustained achievements towards malaria elimination; the robust implementation of the national Plan to Eliminate Malaria including supervised malaria treatment to ensure completion; and the successful integration of the malaria program into a national health service system composed by 29 hospitals, 103 health areas, 771 posts for periodic visits, 1014 EBAIS (Basic Teams of Comprehensive Care), and a network of 126 laboratories.
One of the highlights of the model of Costa Rica’s health system is the home visits conducted by the EBAIS. They go out to the communities and visit each of the houses by various means (horses, motorcycles, boats or walking), identify potential risks that may endanger the health of residents and conduct activities (vaccination, identification of non-communicable diseases among others). The country has a quality assurance program for microscopic diagnosis; and as additional measure, is also implementing real time PCR to detect malaria (allowing the detection of P. malariae cases in 2013-2014).
The malaria risk is highly related to agriculture, especially those coming from other endemic areas of neighboring countries. The innovative strategies for agricultural workers, preventing the introduction of imported cases, and the commitment to malaria elimination primarily through sustained domestic financing, makes Costa Rica an example of how to mobilize a national health system and domestic resources towards malaria elimination.
EL SALVADOR: MINISTERIO DE SALUD PÚBLICA (MINSAL) DE EL SALVADOR
The Vector Control Department, and the National Malaria Programme (NMP) affiliated to the Ministry of Public Health (MINSAL) of El Salvador are the entities responsible for malaria prevention and elimination. Since 2000 the country has achieved a decrease of 98.9% of cases, and reported no deaths since 1998. There is only P. vivax
transmission. Last P. falciparum case was reported in 1995. In 2014, the country reported a total of 8 confirmed cases of P. vivax; all were investigated, and 6 reported as authoctonus and 2 imported from Guatemala.
El Salvador is given the award of Malaria Champion 2016 in recognition of the country’s important and impressive strides made to reduce malaria cases – both autochthonous and imported – to the lowest rates in the history of the country. The NMP has 331 human resources distributed nationwide and dedicated exclusively to malaria activities. The malaria notification network system is integrated with the medical services, 708 Community Family Health Units (UCSF), 376 Basic Family Units (UBS), 294 Intermediary UBS, 38 specialized UBS, 482 Community Family Health Teams (ECOSF), 30 Hospitals of first, second and third level and other private services; resulting in strong malaria surveillance activities.
There is a network of 2750 Volunteer Collaborators (Col-Vol) established in the late 70’s to support diagnosis and treatment. The country has a quality assurance system for microscopic diagnosis and a network of 211 laboratories performing malaria diagnosis. It also participates in the External Quality Assurance Programme. All malaria treatments are strictly supervised, and all detected cases are investigated.
The presence of mobile and migrant population related to economic activities in the country on the borders with Guatemala, Honduras and Nicaragua is also taken into account for stratification and operational planning.
The implementation of key interventions such as active case detection efforts; and the robust domestic financing dedicated to fighting malaria makes El Salvador an example of how to maintain national efforts with a view to elimination.
SURINAME: MINISTRY OF HEALTH MALARIA PROGRAM-SURINAME
The Ministry of Health Malaria Programme in Suriname is responsible of malaria activities in the country. Suriname has reached RBM and the Millennium Development Goals for Malaria. The Annual Parasite Index has dropped from 88 in 2004 to 1.06 in 2015. Malaria has practically been eliminated in the stable villages of the interior-which previously had the highest transmission rates in the Americas, and has decreased to less than 90 autochthonous cases a year. Hospital admissions for malaria have decreased enormously from 377 in 2003 to 11 in 2015 (97%).
Deaths due to malaria have dropped from 24 in 2000 to 1 in 2013, with no deaths recorded in 2014 and 2015. Suriname is recognized as Malaria Champion 2016 for achieving substantial reduction of malaria cases in an area with high malaria burden, accomplished through highly proactive and innovative interventions that transcend borders and ethnicities for the provision of services to populations in situations of vulnerability to foster greater equity and impact.
Since 2009, the MoH Malaria Program in Suriname has a focus on malaria transmission in remaining risk populations and areas, which are mostly mobile, illegal miners from Brazilian origin in gold mines. Imported malaria represented 75% of the number of cases diagnosed last year. KAP studies have been conducted to better approach this population.
The establishment of Malaria Service Deliverers (MSD) to improve access to Diagnosis and Treatment in very hard to reach populations, plus a Malaria Clinic in the capital, mass screening, distribution of LLINs, border posts and case investigation are part of the activities. Some of these areas, depending on priority, are serviced by mobile MSDs, traveling with all-terrain-vehicles or boat. Villages close to mining areas where transmission still occur are considered susceptible to malaria re-establishment and are included in the LLINs distribution.
Suriname’s achievements in public-private partnerships to fight malaria are examples of innovative strategies paving the way for malaria elimination and sustainability. Memorandum of Understandings (MoU) between The Malaria Program and: a) the Medical Mission, b) the largest legal mining company active along the French Guiana border, c) the logging company active in Western and Central Suriname, and d) Institute for Biomedical Sciences, are some examples of partnerships the country has established.