Naomi details the fight to stamp out malaria scourge in Tanzania

QUESTION: Can you tell us what the US President’s Malaria Initiative (PMI) is? Which projects does it support and for how long has it been in the country?

ANSWER: The US President's Malaria Initiative (PMI) is a US government programme launched in 2005 to reduce malaria-related deaths and illness around the world.

It is managed by a partnership between the US Agency for International Development (USAID) and the US Centres for Disease Control and Prevention (CDC), and focuses on malaria high-burden countries in sub-Saharan Africa and parts of Southeast Asia and Latin America.

In 2006, Tanzania was among the first three countries to receive funding under PMI.

To date, Tanzania has received more than $747 million dollars to support the fight against malaria in both the Mainland and Zanzibar.

The key objective of PMI is to complement Tanzania's efforts to control and eliminate malaria through interventions like distribution of insecticide-treated mosquito nets, indoor residual spraying, intermittent preventive treatment of pregnant women, and prompt diagnosis of and treatment against malaria.

You are the first Tanzanian woman to be appointed the U.S. President’s Malaria Initiative Resident Advisor and Malaria Programme Lead at USAID Tanzania.

What does this milestone mean to you and the public health profession?

This appointment is a significant milestone both personally and for the public health profession.

It recognises my expertise, dedication, and contributions to malaria control and public health, validating the hard work and commitment I have invested in combating malaria and improving health outcomes in Tanzania.

Representing my country at such a high level is a source of immense pride, and I hope my achievement will inspire other Tanzanians, especially young professionals, to pursue careers in public health and strive for excellence.

This role brings a great responsibility to lead and positively impact malaria control efforts.

It also provides an opportunity to bring local insights and perspectives to PMI's strategies, ensuring they are effectively tailored to the Tanzanian context.

You are leading the second-largest global PMI programme with funds at $44 million per year, can you tell us how those funds are spent on fighting malaria in the country?

Managing a significant programme with a large budget, it is critical to allocate these funds strategically to maximize the impact on malaria control and elimination.

By strategically allocating funds across WHO-proven interventions, the PMI programme reduces malaria transmission, decreases malaria-related morbidity and mortality, and ultimately, will achieve the goal of malaria elimination in the country.

What are the key malaria projects currently prioritised in Tanzania?
In Tanzania (both the Mainland and Zanzibar), PMI focuses on several malaria interventions to combat and eventually eliminate malaria. The areas of highest priority are:

Vector (Mosquito) Control - Procurement and distribution of mosquito-treated bed nets to households and primary schools, and it prioritises vulnerable groups, such as children under five and pregnant women, through continuous bed net distribution through antenatal care (ANC) and immunization clinics.

Case management - Strengthening malaria diagnostic capabilities by providing rapid diagnostic tests (RDTs) and enhancing laboratory services to ensure accurate and timely malaria diagnosis.

Ensuring the availability and distribution of effective antimalarial drugs, particularly artemisinin-based combination therapies (ACTs), to health facilities and community health workers.

Malaria in pregnancy: Support that ensures pregnant women receive preventive treatment during their antenatal visits to protect them and their unborn children from malaria.

Malaria prevalence rate in Tanzania dropped from 14 percent in 2015 to 7 percent in 2022. How did Tanzania manage to achieve this milestone?

The significant reduction in malaria prevalence in Tanzania is attributed to a collaborative effort between the Tanzanian government, PMI, the Global Fund, and various malaria stakeholders. PMI supported the National Malaria Strategic Plans.

Despite efforts, resources and expertise being put into eliminating malaria in Tanzania, the disease is still high and killing millions of young children and expectant mothers.

What do you think Tanzania is getting wrong despite all these efforts?

There are so many factors that hinder the progress towards the elimination of malaria like coverage and access to insecticide-treated nets (ITNs) and other malaria prevention tools, leading to insufficient coverage, especially in remote and hard-to-reach areas.

Limited access to healthcare services in rural and underserved regions can prevent timely diagnosis of and treatment against malaria, exacerbating the impact of the disease.

There is often low utilisation of treated bed nets because, even when they are available, some households may not use them consistently due to discomfort, lack of awareness, or misconceptions about their effectiveness.

Inconsistent supply chains can lead to stockouts of essential malaria commodities such as ITNs, rapid diagnostic tests, and antimalarial drugs.

Inadequate training, motivation, and distribution of healthcare workers can limit the effectiveness of malaria interventions, particularly in remote areas. 

Inadequate surveillance systems can lead to underreporting and mismanagement of malaria cases, hindering the ability to track and respond to outbreaks effectively.

PMI, together with the Tanzanian government and other malaria stakeholders, is working to address these challenges by strengthening distribution systems to ensure that ITNs and other malaria prevention tools reach all households, especially in remote areas.

Zanzibar faced a malaria surge despite past successes because of climate change. How are you addressing this challenge to ensure there won’t be a resurgence?

We are actively addressing the challenge of malaria resurgence in Zanzibar, together with the Zanzibar Malaria Elimination Programme and other malaria stakeholders in collaboration with Zanzibar’s Ministry of Health.

Recently, this resurgence has been associated with climate change and the resultant prolonged rains last year.

Some of the strategies that are being deployed to combat this issue and ensure sustained malaria control include: Enhancing surveillance and response by strengthening malaria surveillance systems to promptly detect and respond to malaria cases;

Implementing early warning systems that incorporate climate data to predict malaria outbreaks, allowing for timely interventions and resource allocation;

Implementing integrated vector management by distributing insecticide-treated nets and conducting targeted indoor residual spraying campaigns in high-risk areas to reduce mosquito populations; Adapting to climate change by developing strategies that are resilient to climate change.

The projection is that Tanzania will be able to eradicate malaria by 2050. However, Tanzania is still among the top 11 countries globally in terms of malaria infections and deaths. How close or far are we from this goal?

Tanzania has made progress in reducing malaria cases, but achieving eradication by 2050 demands intensified efforts, innovation, and ongoing collaboration among governments, international organisations, NGOs, and local communities. 

While aspirational, this goal remains feasible through sustained commitment and comprehensive strategies that address the complex challenges of malaria.

Former President Jakaya Kikwete advised the Tanzania End Malaria Council to ramp up efforts using successful strategies in light of the prevailing challenges.

What is the outlook?
The outlook for malaria control in Tanzania involves a concerted effort to scale up successful strategies while adapting to emerging challenges.

With political will, sustained funding, private sector and community engagement, Tanzania can make additional strides towards reducing malaria burden and move closer to the goal of elimination.