Malaria Day in the Americas is celebrated each year on November 6th with the goal of promoting awareness, building engagement, and triggering action as the region works towards malaria elimination. It´s also an opportunity to highlight progress made by national programs through an award given by the Pan American Health Organization (PAHO). The Malaria Champion of the Americas award “honors innovative efforts that have significantly contributed towards overcoming the challenges of malaria in sub-regions of the Americas”.
The theme for this year’s Champion of the Americas award, “capacity building as an essential component of malaria elimination and prevention of re-establishment”, reminds us that sustained gains, and eventually elimination, can be harder to achieve than just reducing the number of malaria cases. Therefore, the importance of building capacity among national programs is essential as we make progress towards the end goal.
The 2019 winners were the municipality of Puerto Lempira, department of Gracias a Dios, Honduras, followed by the municipality of La Gomera, Escuintla, Guatemala. This is encouraging news for the region, but for CHAI, it has special meaning as we have been working hand-in-hand with the local level programs of both Gracias a Dios and Escuintla to accelerate elimination efforts for the past three years. Our subnational presence has focused on building the capacity of our local government partners to impact malaria in the highest burden areas.
You can watch the videos for Honduras and Guatemala that PAHO developed highlighting some of the work that contributed to these milestones for each country. The municipality of Puerto Lempira, historically, has represented more than half of all malaria cases reported in the entire country. With a population of 42,700 people living in some of the most difficult areas to reach in all of Honduras, the Ministry of Health and partners working in malaria have had to be creative in developing elimination strategies. Puerto Lempira was recognized specifically for their strategic use of technology in the investigation and georeferencing of each malaria case. CHAI has worked closely with both the Central and Regional levels of the Ministry of Health to develop their Sistema Integrado de Informacion de Salud (SIIS) and to make it a user-friendly tool that encourages not only data collection, but the use of that data for decision making at all levels of the health system. Additionally, CHAI supported the expansion of the community health worker network across the entire department of Gracias a Dios, making access to high quality diagnostics and treatment a reality for these difficult to reach populations. Finally, CHAI has worked with the ministry to transition their indoor residual spraying program from simply reacting to outbreaks to preventing them. The program now uses a proactive campaign timed to prevent cases from happening in the first place, by relying on data that tracks when cases historical peak.
The municipality of La Gomera has historically reported half of all malaria cases in the department of Escuintla, and represents 30 percent of national cases. This municipality is characterized by the presence of large sugarcane plantations that attract over 60,000 workers each year from various parts of the country during malaria season. La Gomera was recognized by PAHO for deploying an intensified package of interventions including surveillance, case management and vector control activities, as well as for the effective coordination demonstrated by partners in the field. “Malaria elimination cannot be achieved behind a desk”, says Dr. Maria Isabel Pedroza, director of the health area of Escuintla in the video. Following that approach, CHAI has supported the local program on a number of fronts. Vector control technicians now keep track of malaria data in their communities and use it to discuss operations; moving from anecdotal information to data for decision making. A comprehensive case management strategy, now includes a public-private partnership with the Guatemala Sugar Cane Association (ASAZGUA) in order to ensure that seasonal workers have access to prompt diagnosis and treatment. We are also supporting the implementation of directly observed treatment to address treatment adherence gaps together with information, education, and communication activities to discourage self-medication and improve treatment-seeking behaviour. Finally, as part of this intensified package of interventions, we have supported the reintroduction of indoor residual spraying in targeted high incidence communities in La Gomera.
At the national level, both Honduras and Guatemala have made substantial progress, with the number of malaria cases dropping from 3,381 and 4,930 in 2014 to 651 and 3,084 in 2018, respectively (an 81% decrease in Honduras and a 37% percent decrease in Guatemala). Despite persistant challenges such as the threat of malaria importation from neighbouring countries and lack of well-integrated data to target interventions in the last pockets of malaria, the progress that was recognized in Honduras and Guatemala this year will continue to build momentum throughout the region. As a trusted partner to both governments, CHAI will be there to roll up our sleeves and work closely with the malaria programs in the region to achieve and sustain the elimination goal.
