Roll Back Malaria Progress & Impact Series:
Focus on Senegal
Focus on Senegal, the first country report in the Roll Back Malaria Progress & Impact Series, published in collaboration with Senegal’s National Malaria Control Programme, (NMCP) describes how Senegal achieved a spectacular drop in its malaria burden in just five years.
A summary of Senegal’s main achievements
- Between 2005 and 2010, nearly 6 million insecticide-treated mosquito nets have been distributed. In 2010, 82% of households own at least one insecticide-treated mosquito net, representing a 36% increase in less than two years.
- All of the country’s 14 regions have received free intermittent preventive treatment for pregnant women. Fifty-two per cent of pregnant women received at least two doses of sulfadoxine-pyrimethamine during antenatal medical consultations in 2008-09, compared with 13% in 2005.
- 1 million rapid diagnostic tests and 1.5 million artemisininbased combination treatments have been distributed free of charge since 2007. Between 2008 and 2009, 17 000 health workers have been trained to use these tests and dispense these treatments. 86% of patients presenting with a suspected malarial fever were screened with a rapid diagnostic test in 2009.
- 330 000 household rooms were sprayed with insecticide between 2006 and 2009.
- The country’s 69 health districts all receive support for community information, education and communication activities (ABCD programme).
The burden of malaria in Senegal
Malaria has been a longstanding public health problem for the people of Senegal. In 2005, approximately 2 million cases of malaria were recorded in the country, as were more than 2000 deaths attributable to the disease. While the South of Senegal is hyperendemic, the Northern part of the country is hypo-endemic, with a low rate of malaria transmission.
Senegal’s National Malaria Control Programme
Created in 1995, the NMCP underwent a major reorganization in 2005 after cancellation of the Global Fund Round 1 grant. By 2005, Senegal had established an effective malaria control programme based on strong management and well-defined plans.
The implementation of good managerial and programmatic practices attracted increased donor funding. In 2004, external funding amounted to US$ 1 million, as compared with US$ 30 million committed for 2010 by the Global Fund and US-PMI. Other partners, like the World Bank, WHO, UNICEF, and the Islamic Development Bank, have made growing contributions. Overall, more than US$ 130 million was mobilized between 2005 and 2010 to scale up the fight against malaria.
Increased funding enabled the NMCP to intensify its activities, and thereby to expand the coverage of key malaria control interventions (insecticide-treated mosquito nets, indoor residual spraying, intermittent preventive treatment during pregnancy, rapid diagnostic tests, and artemisininbased combination therapy).
A key element of Senegal’s success in making malaria control accessible to all—including those living in isolated areas—is its homebased care programme, known as PECADOM. Under this initiative, trained volunteers visit patients at home, administering rapid diagnostic tests and dispensing treatment where required—all free of charge to the patient. In 2009, 97% of patients seen by a homebased care provider and diagnosed with malaria were treated at the community level (i.e. without having to be referred to the next level of the health-care system), with a 100% recovery rate.
The NMCP has always acted on the basis of operational research. The NMCP plans and coordinates malaria research activities ranging from clinical trials, to drug quality control, to antimalarial medication efficacy monitoring and feasibility studies. In this way, key interventions can be based on operational research data. Furthermore, the existence of several partnerships between the NMCP and university hospital centres and research institutes allow doctors and senior health technicians to receive appropriate, malaria-specific training.
Senegal has implemented many innovative strategies to educate the general public about malaria, which have involved national celebrities and footballers, religious leaders, the private sector and non-governmental and community organizations. For example, Youssou N’Dour, an internationally renowned artist and Goodwill Ambassador for UNICEF and the RBM Partnership, launched an information and education campaign to intensify malaria prevention messages. Using multiple channels of communication including a singing competition, the network of community health workers, and the mobilization of civil-society partners, this initiative has had a demonstrable impact.
While the NMCP has many strengths that are highlighted above, the report also notes the programme’s weaknesses. For example, coordination between the NMCP and the central pharmacy could be improved, as there often are supply shortages; the organizational and operational capacities of the community support networks could be better utilized, especially for treatment and monitoring; and epidemiological monitoring is weak, with only 15 sentinel sites in the flood-prone regions around Dakar and in the Senegal River valley.
While the results achieved in malaria control in Senegal have been remarkable, human and financial efforts must be maintained in order to sustain the progress made thus far and avoid a resurgence of malaria. The coming years will provide Senegal and its partners with a unique opportunity: the chance to roll back malaria on a large scale with unprecedented force.
Cases of malaria, Senegal, 2006–2009
The impact on malaria morbidity is also apparent, although it is more difficult to quantify because of a change in the way cases are defined. Before 2007, malaria cases included suspected cases with no laboratory confirmation by microscope or rapid diagnostic test, while from 2007 all reported cases of malaria were laboratory-confirmed. From then onwards, the data are genuinely comparable. The number of confirmed cases went from 295 000 in 2008 to 174 000 in 2009, a reduction of 41% in a single year.
Source: NMCP, 2010.