MOSASWA Cross Border Initiative
The goal of this program is to work collaboratively to accelerate from control to pre-elimination in southern Mozambique and accelerate the transition from pre-elimination to elimination of malaria in Swaziland and South Africa, so as to achieve zero local transmission in Swaziland, South Africa and Maputo province by 2020 and achieve pre-elimination status elsewhere in southern Mozambique by 2025.
- To establish and operationalize the MOSASWA malaria cross-border initiative to coordinate, harmonize policies, strengthen sub-national capacity and share expertise and strategic information among the three countries to accelerate to the goal of malaria elimination.
- To expand and sustain access to malaria elimination interventions across the MOSASWA region with particular focus on mobile and migrant populations (MMP), malaria risk localities and residents so as to rapidly reduce and interrupt malaria transmission.
- To strengthen capacity in the three countries for malaria surveillance, operational research and monitoring and evaluation to support elimination efforts, respond to outbreaks and resurgence, and generate evidence for intervention response.
- To mobilize resources and advocate for increased and sustainable malaria financing to achieve and sustain malaria elimination.
- Establishment of a regional zone of malaria control between South Africa, Swaziland and Mozambique to accelerate South Africa and Swaziland to achieving malaria elimination within the planned timelines.
- Setting Maputo Province on the path to malaria elimination through the establishment of a sustainable malaria control program; this will include strengthening of entomological surveillance and implementation of the Indoor Residual Spraying program.
- Strengthening monitoring and evaluation in the MOSASWA region through strengthening local health systems and implement new technologies in data collection and monitoring and evaluation.
- Build a sustainable long-term funding solution for malaria control and elimination efforts in the MOSASWA region by mobilizing private sector support.
- Other specific objectives are supporting indoor residual spraying in southern Mozambique, thus targeting sources of infection for Swaziland and South Africa, as well as capacity building for entomological surveillance.
The malaria burden in border districts between Mozambique, South Africa and Swaziland (MOSASWA) varies across the MOSASWA countries with some areas in South Africa and Swaziland, reporting an incidence rate of less than 0.01 cases per 1,000 population, and others in Mozambique reporting rates of up to 500 cases per 1,000 population.
While South Africa and Swaziland have a relatively low case burden and are well-embarked on the road towards malaria elimination, malaria prevalence in Mozambique reaches up to 55% in some areas. It is still the major cause of morbidity and mortality in Mozambique and accounts for 44% of all outpatient consultations and 29% of hospital deaths.
It is unlikely that South Africa and Swaziland will be able to eliminate malaria transmission unless (i) malaria prevalence in the southern provinces of Mozambique bordering South Africa and Swaziland is substantially reduced; and (ii) interventions effectively target mobile and migrant populations travelling back-and-forth between the three countries.
The program builds on the Lubombo Spatial Development Initiative 2 NPC (LSDI), a private-public partnership malaria program implemented between 1999 and 2011, and which demonstrated the potential impact of cross-border collaboration on malaria transmission in the three countries.