Lubombo Spatial Development Initiative and malaria control
Malaria control forms a component of the Lubombo
Spatial Development Initiative (LSDI). The LSDI is a programme by the
governments of Mozambique, Swaziland and South Africa to develop the Lubombo
region into a globally competitive economic zone, ensuring sustainable employment
and equity in access to economic opportunity in the region. The geographic
region targeted by this initiative is broadly defined as eastern Swaziland,
southern Mozambique and north-eastern KwaZulu Natal, an area linked by the
Lubombo mountains.
Malaria was identified as a critical deterrent to the development of the Lubombo
region. This led to the creation of the Lubombo Malaria Control initiative,
a cross-border collaboration aimed at the reduction of malaria throughout
the LSDI area.
The objective of the malaria component is to put in place a
malaria control programme that will protect the economic interest of the Lubombo
Spatial Development Initiative (LSDI) and stimulate development. Promoting
the area for development will only be effective once it has been clearly shown
that the risk of being infected with malaria is decreased, and that there
is an ongoing, sustainable malaria control programme in place.
This initiative, the first African cross border malaria control collaboration, was initiated using private sector money. Currently the LSDI is being funded by the Global Fund and the Mozambican government. The control programme comprises two arms, vector control using indoor insecticide residual spraying and parasite control through effective malaria diagnosis and treatment. Following the successes in controlling malaria, particularly in Maputo Province, Mozambique, the LSDI was extended northwards into Gaza Province, Mozambique in 2006. At present the area under malaria control across the three countries involved in the LSDI exceeds 200 000 km2.
The Regional Malaria Control Commission (RMCC) is the coordinating
and decision-making body of the LSDI programme, which comprises malaria control
programme managers, public health specialists and scientists from the three
countries. The MRC Malaria Research Programme undertakes direct management
of the day-to-day running of the programme on behalf of the RMCC, and provides
secretarial, financial management, fund-raising and research support as well
as chairing the RMCC.
The objectives of the LSDI Malaria Control Initiative are briefly
outlined:
- extending indoor residual spraying (IRS) to Maputo Province, Mozambique
and ensuring effective malaria control was maintained in South Africa and
Swaziland.
- monitoring and evaluating malaria control in the region and developing
a regional GIS-based Malaria Information System (MIS).
- providing updated tourist information booklets containing definitive
malaria risk maps and prophylaxis guidelines.
- monitoring the negative impact of malaria and the beneficial effects
of malaria control on communities, tourism and development.
- ensuring sustainability of malaria control through appropriate capacity
development, fund raising and integration of control activities within the
provincial health system in Mozambique.
Since effective malaria control requires both vector control
and early effective treatment, the RMCC decided to extend their objectives
to ensure that the best malaria treatment was introduced across the LSDI.
Widespread use of artemisinin-based combination therapy (ACT) offers the benefits
of not only improving cure rates, but, unlike other malaria treatments, of
also directly decreasing malaria transmission and potentially slowing drug
resistance. To optimise the synergistic effects of indoor residual spraying
(IRS) and ACTs on reducing malaria transmission and thus disease burden, while
minimising programme costs, the implementation of ACTs has been timed to follow
the establishment of effective vector control.
The effectiveness of the malaria control programme in the long-term
will be assessed by the incidence of malaria over time in Mozambique as well
as in the neighbouring malarious areas of South Africa and Swaziland. The
success of intervention is not only measured using process (e.g. spraying
and artemisinin-based combination therapy coverage) and biological markers
(e.g. parasite prevalence rates, health facility patient numbers and mosquito
vector reductions), but also by the effects on tourism (e.g. bed occupancy,
job creation and risk perceptions) in all three countries over the course
of the project.
Progress
- In 2003 the project with the MRC as the Principle Recipient was awarded a Global Fund allocation of US$ 22 million over 5 years. A second grant, valued at US$?? was made to the MRC in 2006, to extend the malaria control efforts into Gaza Province in Mozambique.
- The project also receives financial support from the private sector and the Mozambican government.
- Due to capacity development some of the management of the project has been transferred with Mozambican Ministry of Health.
- As a consequence of the expansion of the LSDI into Gaza Province, Mozambique, the region under malaria control across the three countries now exceeds 200 000 km2.
- Both the drug and insecticide policy in the three collaborating countries have been changed based on research conducted by the MRP.
- In collaboration with the London School of Hygiene and Tropical Medicine, Plasmodium falciparum gene flow studies have contributed to a better understanding of the development and spread of SP resistance, and its implications for effective regional anti-malarial policy.
- The rapid emergence and spread of SP resistance markers in Mozambique, following the introduction of the combination antimalarial, artesunate plus SP, poses a major threat to the long term efficacy of this drug in the LSDI region.
Project Components:
See Lubombo
SDI Malaria Control Programme Web site
