Malaria elimination in Zanzibar: where next?

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Policy

Background:

• Zanzibar's National Malaria Strategic Plan IV (2018-2023) aimed for malaria elimination by 2023.
• An end-term review assessed implementation progress, health system effectiveness, and financing.

Purpose of the Study:

• To evaluate the progress of malaria elimination efforts in Zanzibar.
• To assess the effectiveness of health systems in malaria case management.
• To analyze malaria financing within the national health budget.

Main Methods:

• A mixed-methods approach combining desk review of malaria data and reports.
• Field visits to health facilities and communities.
• Interviews with healthcare professionals and residents.

Main Results:

• Annual parasite incidence (API) increased from 2.7 to 3.6 cases per 1,000 population (2017-2021).
• Approximately 68% of malaria cases were imported.
• Malaria case follow-up and investigation rates improved significantly.
• Overall health budget increased, but malaria's share remained below 1%.

Conclusions:

• Malaria elimination progress is uneven, with significant imported cases.
• Increased health sector funding has not proportionally benefited malaria control.
• A sub-national, targeted approach is recommended for malaria elimination.
• Sustained elimination requires increased dedicated malaria funding.