Health equity should be pursued not only as a moral imperative of social justice, but as a practical measure to support progress towards achieving the global health targets set under SDG3. Achieving equity in health programming, will require a comprehensive healthcare approach including assessing and breaking down populations’ barriers to timely access to necessary healthcare services. In the context of malaria, this includes quality, timely, and affordable prevention, diagnosis, and treatment services for affected populations . The fight against malaria is one of the biggest public health successes of the 21st century. Global malaria death rates have decreased by 60 percent since 2000 – translating to millions of lives saved. However, after an unprecedented period of success, progress in malaria control has stalled. The World Malaria Report 2018 estimates that there were 219 million cases of malaria in 2017. The 10 highest burden African countries saw an estimated 3.5 million more malaria cases in 2017 compared with the previous year. According to the report, every two minutes, a child dies of malaria. The agenda set by the international health community to get back on track to malaria elimination is ambitious. The World Health Organization (WHO)
Global Technical Strategy for Malaria (2016-2030) and the
Action and Investment to Defeat Malaria (AIM) 2016-2030 call for an incidence and mortality reduction of at least 90% globally; and malaria elimination in at least 35 countries by 2030. Recently, WHO and the
RBM Partnership to End Malaria (RBM) launched a massive wakeup call with a response termed the High Burden to High Impact approach in an attempt to
support targeted responses and increase political and community commitment to re-ignite the pace of progress in the global malaria fight. In line with the equity and universal health coverage agenda, meeting the global health agenda to end malaria will require more information on the context and determinants underpinning the implementation of malaria programmes.
Malaria is closely linked to low socio-economic development and inequity. Low socioeconomic status (SES) doubles the likelihood of clinical malaria or parasitaemia in children compared with children of higher status within the same locality. The probability of dying from malaria in Sub-Saharan countries in inversely related to the Human Development Index (HDI) for income and education.
Social inequalities in malaria endemic settings may result in lack of access to treatment due to cost, lack of information about malaria, lack of access to preventive measures, such as insecticide-treated nets (ITNs), delayed treatment seeking behaviour or lack of access to treatment for malarial symptoms and, poor housing, among other factors. The likelihood of being infected with malaria is higher in poor and marginalized communities. Yet, malaria itself is a burden to communities and increases poverty and inequality due to lost productivity or income associated with illness or death. Success of vector control and case management interventions should be evaluated by their impact, which will be determined by
effective population coverage for affected populations and, successful individual access and uptake in targeted populations, particularly disadvantaged or hard to reach populations. To achieve this impact, successful malaria strategies should include interventions that are:
Integrated: addressing malaria not only as a health issue, but in a multi-sectoral context, as a developmental, economic, political, environmental, agricultural, educational, biological, legal, security and social issue.
Equitable: ensuring that social behaviour change communication, vector control, diagnosis and treatment services reach all populations at risk of malaria, including building in consideration for differentiated barriers that certain populations face in accessing services.
People-centred: ensuring that the experiences and particular needs of target populations actively inform the design of malaria interventions, including decisions about community versus facility-based deployment and the dynamic of interactions between service provider and client.
Aligned with the principles above, the present toolkit was designed to guide improvement of the quality, effectiveness and outreach of malaria responses by bringing into perspective how biological, social, economic, cultural and gender-related inequities can shape malaria prevalence and/or outbreaks in a country or region. By correlating malaria epidemiological data with a robust analysis on key social determinants of health, the tool contributes to increase the reach and uptake of prevention and care services, particularly by underserved populations.
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