National Malaria Control Program
MALARIA SITUATION ANALYSIS
The National Malaria Control Program, then Malaria Control, was established in 1944 after signing the lend-lease agreement with United States. Liberia sought assistance in planning for improvements in the sanitation of Monrovia and other coastal towns. The request was folded into the military programme in Liberia that saw the United States Public Health Service (USPHS) mission to Liberia in 1945.
The USPHS team began the use of synthetic insecticides Dichloro-diphenyl-trichloroethane (DDT) in kerosene for indoor residual spraying (IRS) and as a larvicide, along with some drainage operations in Monrovia, with the goal of controlling malaria in the capital. Even though the “mosquito control project” was expensive, observers believed it produced some positive health results. Malaria admissions to the public health hospital in Monrovia decreased by almost 95% from 383 in 1945 to 21 in 1947.
The local community’s access to antimalarial drugs that reduced the severity of the malarial attacks, as well as the vector control programme are believed to have contributed to this decline. While the local Americo-Liberians viewed this and the additional benefits of reduction in mosquitoes and nuisance insects positively, the high cost of the programme made it unsustainable and the Americans ended their support. Later in the early ‘50s, the project was “scaled up” by the WHO, in collaboration with UNICEF to reach the surrounding areas in the Central Province (Kpain).
While the Monrovia mosquito control project constituted the first large-scale use of synthetic insecticide to combat malaria in tropical Africa, the “Kpain Project” was one of a first cluster of projects initiated by WHO to explore the efficacy of IRS with the goal of determining the feasibility of malaria eradication in tropical Africa. These projects encountered difficulties that foreshadowed the general retreat from malaria eradication efforts across tropical Africa by the mid-1960s.1 The Malaria pre-eradication project was folded into the Department of Basic Health Services in January 1968, headquartered in Monrovia. Little is known about malaria control in Liberia in the 70’s and 80’s under the stewardship of the Department of Basic Health Services.
Malaria Control during the civil war (1989-2003)
Malaria control interventions during the civil crisis mainly consisted of case management, indoor residual spraying and use of insecticide-treated tarpaulins because of the complex emergency with support from humanitarian agencies. The most significant event in malaria control efforts during this period was the revision of the malaria treatment policy in 2003 from chloroquine to Artemisinin-based combination therapy (ACT) following efficacy study findings in 2002 that showed development of parasite resistance to chloroquine and Sulfadoxine-pyrimethamine (SP), the first and second-line drug of choice for treatment of uncomplicated malaria, respectively.
Malaria Control in Post-War Liberia (2005 to present)
In 1998, WHO, UNICEF, UNDP and the World Bank launched the Roll Back Malaria initiative in an effort to provide a coordinated global response to the disease with an overall strategy to reduce malaria morbidity and mortality by reaching universal coverage and strengthening health systems.2 The RBM strategy together with other initiatives such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM) and the United States President’s Malaria Initiative (PMI) provided the unique opportunity for renewed efforts by the Government to mobilize resources towards malaria control in Liberia.
Between 2005 and 2020, the programme developed four strategic plans, all aligned with national and international goals and targets, and geared towards reducing the burden of malaria on the population. The Government of Liberia and several international development partners (mainly the GFATM and PMI) have invested extensively in four key malaria control interventions: a) insecticide-treated nets (ITNs), b) IRS in selected areas, c) intermittent preventive treatment in pregnancy (IPTp), and d) prompt and effective malaria case management. Even though the targets have always been 80% population coverage and use, the malaria programme has managed to achieve more than 50% population coverage with key interventions including LLINs, parasite- based diagnosis and treatment with recommended antimalarial and increased knowledge on malaria prevention and control, thus contributing to steady decline of malaria burden over the years.
Advocacy, Communication and Social Mobilization
Currently, the MOH&SW has developed the framework for community involvement in health and the NMCP has strong collaboration with partners for the promotion of IEC/BCC and community involvement in health. Strategic documents, Community Health Development Committees (CHDC), and community-based health program have been developed and are contributing to raising awareness on Malaria at community level. Indicators and targets for the IEC/BCC intervention are captured in the NMCP Strategic Plan 2010 – 2015.
The IEC/BCC strategy has increasingly reached its targets in the areas of knowledge on malaria transmission and malaria prevention. The MIS indicate that between 2005 and 2011, the knowledge on malaria transmission and prevention has increased from 43.1% to 83% in the MIS 2005 and 2011, respectively. The DHS 2013 indicate reported that 97% of the population know about malaria transmission and prevention. Unfortunately, however, translating knowledge into practice lags behind knowledge. The DHS 2013 reported utilization of ITNs among children under five to be 36% although 55% of households had an ITNs. Additionally, although 97% of the population know malaria can be treated only 58% of children with fever were sent to health provider for management.
The vision of the malaria programme is a healthier Liberia with no malaria death.
Mission and Values
The Mission of the national malaria control programme is to provide universal, coordinated, cost effective and evidence-based malaria interventions for the people of Liberia.
Goal and Objectives
Goal: By end of 2025, reduce malaria burden by 75% (11% overall prevalence) compared to 2016 (45% prevalence). Liberia aims to gradually transition from high burden (>10% transmission) to medium to low burden (<10% transmission) in preparation for pre-elimination phase. The most appropriate way to record progress towards achieving this goal is to track the number of malaria cases and deaths nationally through the HMIS. Thus, an improved and robust national surveillance system based on quality HMIS data, complemented by population-based surveys that estimate prevalence, will be used to measure malaria burden reduction.
1. By end of 2025, reduce malaria mortality rates by at least 75% (43/100,000 population) compared to 2016 (172/100,000 population)
2. By end of 2025, reduce malaria case incidence by at least 75% (95/1,000 population) compared to 2016 (380/1,000 population)
3. By end of 2025, promote and maintain a culture of evidence-based decision making to achieve malaria programme performance at all levels 4.4. By end of 2025, strengthen and maintain capacity for programme management, coordination and partnership to achieve malaria programme performance at all levels