Malaria is still a prominent public health issue in tropical and subtropical areas worldwide. Despite significant achievements in the global effort to control the disease, it is still a formidable challenge for much of the world. China has also been a malaria-endemic country, which obtained lasting and remarkable achievements in malaria control and malaria elimination. Malaria elimination has currently been reached in China. China’s contribution and experience provide valuable insights on adequate control of malaria in other countries. This article presents the key elements of China’s approach in the fight against malaria and elaborates on the corresponding measures that other countries can take to improve the malaria control program.
China’s Malaria Control Journey
China’s transformation from a malaria-endemic nation to a malaria-free nation demonstrates that the goal of malaria elimination can be achieved in countries with comprehensive and sustained malaria-control programs. Keys to China’s success included:
1. Integrated Malaria Control Program
Its malaria control program incorporated a multi-pronged approach of vector control and clinical intervention measures:
- Vector Control: In addition to antimalarial treatment and surveillance, effective vector control is another core element of China’s malaria program. China had a strong insecticide-treated nets (ITN) program several years before the recent push at the global level and continues to advocate for ITNs, as well as indoor residual spraying (IRS) and environmental management for breeding-site control.
- Case Management: Treating people early, when malaria symptoms first appear, can prevent complications. People with symptoms should be tested immediately with rapid diagnostic tests (RDT) and given effective antimalarial medicines such as artemisinin-based combination therapies (ACT).
- Robust surveillance and monitoring: China has been able to track malaria cases, identify outbreaks, and monitor the impacts of control measures, for example, with the help of robust surveillance systems and digital health technologies for data collection and analytic purposes.
2. Strong Government Leadership and Policy Framework
The Malaria Control04-2015) details exactly how China achieved its victory over malaria:
- Day Zero: There is now a government-supported national malaria control program, in effect a highly successful national program The AECs ensure organizations and individuals coordinate their efforts and resources in their goals.
- Policy Enabling Conditions: The Chinese government has supported continued work on malaria control by promulgating regulations for vector control, funding research, and producing policy guidance on case management.
- Intersectoral Collaboration: collaboration among different ministries, particularly health, the environment, and agriculture, improves the implementation of malaria control interventions.
3. Community Engagement and Education
Community involvement has been a key element in China’s malaria control strategy:
- Community Health Workers (CHWs): CHWs have played a central role in identifying, treating, and preventing malaria at the local level with the additional benefit of reaching remote or underserved areas through training and deployment.
- Public education campaigns: Educating communities about the prevention and treatment of malaria can dramatically enhance community participation in malaria control measures.
4. Research and Innovation
China’s commitment to research and innovation has supported its malaria control efforts:
Development of New Diagnostic Tools, Treatments, and Insecticides In the past, advancement in diagnostic tools, treatments, and insecticides was slow, as previous epidemics in the Western world have shown. Vectors usually become resistant to insecticides, and when new drugs are created, the pathogens become immune. Improved diagnostic tools and antibiotics came out of those epidemics, but it was a painful and lengthy process. China, on the other hand, has given priority to developing new diagnostic tools, medicines, and insecticides, from insecticidal soaps to rapid diagnostic tests.
Operational Research: Evidence from operational research on the use and effectiveness of malaria control interventions and strategies is feeding directly into policy and practice for ongoing improvement in malaria control.
Lessons for Other Nations
China’s significant progress in controlling and eliminating malaria should be an inspirational lesson to other countries seeking to enhance their malaria control programs, so here is the summary of the lessons learned and recommendations:
1. Adopt a Comprehensive and Integrated Approach
In many ways, other countries could learn vital lessons from the Chinese malaria experience, particularly in converting vector control, case management, and surveillance into a single coherent national malaria-control program. Countries could do this by:
- Multi-pronged Intervention: Pair ITNs and IRS with mosquito control and management to lower mosquito numbers and transmission rates.
- Ensure Access to Diagnostics and Treatment: Make rapid diagnostic tests and effective treatments widely available to manage cases correctly and on time.
Enhance surveillance systems to detect malaria cases, map outbreaks, and know whether control is working.
2. Build Strong Government Leadership and Support
Strong political leadership and policy support are needed to successfully control malaria Strong political leadership and policy support are needed to stop malaria in other countries.
- Establish National Programmes: Develop and fund national malaria control programs with goals, strategies, and resources.
- Put in place Supportive Policies: Develop policies that are conducive to scaling up malaria control by regulating vector control and investing in research and development.
- Facilitate Intersectoral Collaboration: Stimulate participation from the health, environment, and other relevant sectors to improve malaria control.
3. Engage and Empower Communities
Community involvement is essential for effective malaria control. Countries should:
- Deploy Community Health Workers. Deploy CHWs at the local level to screen for, treat, and prevent malaria, especially in rural, remote, and underserved areas.
- Public Education Campaigns: Raise awareness about preventing and treating malaria. Public education campaigns increase community participation and compliance.
4. Invest in Research and Innovation
Ongoing research and innovation are critical for advancing malaria control efforts. Other nations should:
- Fund Rise-of-the-Machine Endeavours: Back development of better diagnostic, therapeutic, and preventive tools, through investment in research.
- Encourage Operational Research: Research the implementation and impact of malaria control interventions and policy and practice decisions.
5. Ensure Sustainable Funding
Sustainable funding is necessary to maintain and expand malaria control efforts. Countries should:
- Make Sure There’s Enough Money: Provide adequate funding for these malaria control programs including vector control, case management, and surveillance.
- Seek International Support: Cooperate with global organizations and partners for supplementary funding and technical assistance.
China’s achievements offer a model for countries that are striving to control malaria. With the commitment to implementing an integrated intervention strategy, building political will and institutional leadership, mobilizing communities, investing in research and development, and consistent funding, other countries can put in place far stronger malaria control programs that can generate additional milestones in malaria control.
China’s experience should remind the international community that malaria is preventable and treatable. All countries striving to deal with the health, economic, and social burdens of the disease should take inspiration from China. By learning from its successes, and adapting the strategies to local settings, countries around the world can move closer to saving more lives and ultimately, eliminating the disease.
