Despite the decreasing global incidence of malaria, the disease remains a public health problem worldwide, affecting mainly developing countries in Africa, Asia and Latin America. It continues to be endemic in 21 countries of the Americas, with an estimated 427,000 cases per year. Approximately 10 per cent of these cases occur in the Mesoamerican and Caribbean regions. During the last decade, malaria transmission in Mesoamerica showed a decrease of about 85 per cent, whereas in the Caribbean region, Hispaniola (the Dominican Republic and Haiti) experienced an overall rise in malaria transmission due primarily to a steady increase in Haiti, while in the Dominican Republic, there was a significant drop in transmission.1

This recently observed significant reduction in malaria in the region has galvanized the launch of the initiative for the Elimination of Malaria in Mesoamerica and Hispaniola to finally eliminate local cases of malaria in participating countries by 2020 and achieve full World Health Organization (WHO) certification by 2025. The initiative embraces a three-pronged approach : (a) stimulating a shift from malaria control to pre-elimination and ultimately elimination; (b) incentivizing countries to accelerate the pace towards malaria elimination; and (c) reducing local malaria cases by linking achievements to a results-based financing mechanism. All countries work to revise their national strategies towards elimination. Results and advancement towards elimination are confirmed annually through an evaluation mechanism coordinated by WHO/the Pan American Health Organization (PAHO).

Preliminary data have shown the impact of the initiative throughout the region and especially in the Dominican Republic, where interventions have reduced the number of malaria cases and have had the simultaneous impact of reducing lymphatic filariasis and controlling dengue, underlining how steps in malaria elimination can also decrease the level of neglected tropical diseases. The initiative introduces coordinated efforts in participant countries, supports individual national efforts in the transition from control to elimination, and coordinates technical assistance and support of multiple partners in a single visible objective. All revised national strategies therefore focus on elimination. In some cases, stratification at the municipality level makes it easier to more accurately focus available resources to tackle the disease using the most appropriate techniques, such as the “Test, Treat and Track”-focused use of bed nets, case investigation, targeted interventions and intersectoral, cross-border collaboration.

The initiative has a strong partnership focus, the political commitment of participating countries, national ownership and the expected availability of additional national investment, which together guarantee the long-term success of this approach. It has been used as a model for adapting similar interventions in other malaria- prone regions where there is the possibility of reaching regional consensus (governments, technical agencies, affected communities) to eliminate the disease.