How much is Africa losing to malaria?

At Hoima Regional Referral Hospital, in Western Uganda, Tulinawe Kabaami is anxiously watching over her 3-year-old son, who has been battling severe malaria for the past five days.

Tulinawe describes the harrowing journey from a local health center to the regional hospital, where her son’s condition worsened despite initial treatment. “He became weak one evening, and I gave him medication, but he didn’t improve. The next day, he fell down and became unconscious. I rushed him to the hospital where he was treated but had to be referred here due to severe conditions,” Kabaami says.

Although the family received mosquito nets from the government, Tulinawe admits they have not been used.

The family has already spent about $100 on treatment, but there is little improvement.

They had to sell property to raise the money. The cost of treating malaria is a burden even for government which was told by donors in March, to fund malaria fight on their own.

Dr. Gilbert Ategeka, a pediatrician at the hospital, notes a troubling trend. He reports that three out of ten children admitted test positive for malaria.“People now have fish, they use them for fishing. But the government, if they teach them very well how to implement that the mosquito nets were given to you to put on your bed and then prevent malaria in your family and people to be taught that if someone is sick in the family there is economic cost. Children will not go to school because money will be taken to hospital to take care of this one who is sick. So, the government needs to be on the ground and the VHTs(village health teams) should also be encouraged and facilitated to do their work of teaching people to use mosquito nets.”

While the global community has invested $3.5 billion in malaria efforts, more than double that amount is needed to meet the 2030 elimination target. With African governments already struggling with weak health systems and limited resources, this shortfall could have dire consequences.

In a meeting on the sidelines of the World Health Organisation Regional Committee for Africa in Brazzaville, the RBM Partnership highlighted a disturbing trend. Despite significant progress over the past two decades, malaria cases and deaths have surged in recent years, particularly across Africa. 90 percent of malaria cases and deaths occur on the continent.

Dr. Michael Adekunle Charles, CEO of the RBM Partnership, describes the situation as an "unacceptable injustice”, emphasizing that malaria's impact is exacerbated by existing vulnerabilities, such as displacement, conflict, and gender inequalities, which compound the challenges of eradicating the disease.

While the past two decades saw progress in the fight against malaria, with dedicated innovation averting 11.7 million deaths from the disease, there has been a resurgence in recent years, the partnership further pointed out as they met African leaders at the sidelines of the World Health Organisation (WHO) Regional Committee for Africa meeting in Brazzaville, Republic of Congo. Africa is the hardest hit, as over 90 percent of malaria cases and deaths occur on the continent.

“This is a disease that is intersecting with other inequalities and mostly affecting people on a continent that already has complex challenges that we are yet to properly address. When malaria mixes with existing poverty, rising conflict and displacement, the vagaries of climate change and gender inequalities, it breeds an injustice that widens the gap within Africa; and between Africa and other parts of the world,” RBM Partnership CEO, Dr Michael Adekunle Charles said as he called for a multisectoral approach that recognizes and addresses the way malaria affects other development aspects.

He said that this combination of factors is making it hard to effectively deal with the malaria parasite and the anopheles mosquito that carries it, as these two are also constantly evolving and becoming resistant.

“Biological threats in the form of malaria parasites resistant to treatment and mosquitoes resistant to insecticide are threatening our progress in the fight against malaria. We must move fast to outsmart the disease before it outsmarts us. That most of the world eliminated malaria decades ago but Africa still grapples with the disease is an unacceptable injustice – and an indication that we are not doing enough to end malaria,” he added.

An estimated 70 percent of global malaria deaths occur in 11 African countries: Burkina Faso, Cameroon, the Democratic Republic of Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda and Tanzania. These countries also rank in the lower side of the Human Development Index. In March, the 11 countries signed the Yaoundé Declaration – committing to stop malaria deaths and take more decisive steps to eliminate the disease.

While the SDGs envisage ending malaria by 2030, giving it high priority alongside HIV and TB, only $3.5 billion has been invested in ending malaria. This is less than half of the $7.3 billion needed to eliminate malaria by the 2030 target.

Further, African governments, who are already facing weak health systems and stalling development are finding it hard to find resources to meet national malaria goals. They are collectively facing a $1.5 billion budget shortfall and cannot sustain the already inadequate coverage of essential malaria interventions.

If funding for malaria does not increase to meet the growing needs, the RBM Partnership says, this shortfall, linked to the global financial crisis and the higher cost of essential commodities, could result in malaria deaths doubling – mirroring worst-case scenarios predicted at the outset of the COVID-19 pandemic.