How One Region in Senegal is Leading the Battle Against Malaria

With an incidence rate of less than 5 cases per 1,000 inhabitants, Senegal’s Saint-Louis region – which accounts for 6% of Senegal’s total population – is closed to sub-national elimination of malaria and conducts regular malaria case investigations to further disrupt local transmission.

Through several initiatives bolstered by the USAID Building a Resilient Health System (BRHS) project implemented by Chemonics, the incidence of malaria in Senegal’s Saint-Louis region is trending downward. BRHS has facilitated swift action in case tracking and investigation, with 97% of index cases documented and notified within 24 hours, and 84% of eligible cases investigated within 72 hours (see table below) . Between September 2023 and June 2024, Saint-Louis’ five districts reported a total of 1,917 malaria cases, representing an incidence rate of 1.59 cases per 1,000 inhabitants. More than half of the index cases (56%) were classified as locally transmitted, underscoring the ongoing need for precise and timely responses. The BRHS project’s performance-based financing model has supported these efforts, offering both trainings and financial incentives to health workers to strengthen timely case documentation, notification, and investigation of malaria cases in the region.

These results demonstrate the commitment observed across both public and private health facilities. The emphasis on timely case documentation ensures rapid, tailored responses to emerging cases. In the districts of Richard Toll, Dagana, and Pété, health workers documented and recorded 100% of index cases in the DHIS2 tracker platform, which helped facilitate follow-up actions. “Every minute counts,” stressed a local health worker, underscoring the critical role of speed in controlling malaria cases.

Strong Private Sector Participation in Malaria Detection and Documentation

One key contributor to the decreased malaria incidence rate in Saint-Louis has been the active participation of the private sector. Various organizations, including the Regional Center for University Works of Saint-Louis, the Health Training and Research Unit at Gaston Berger University, private healthcare facilities, companies such as the Senegalese Sugar Company, and the health services of the Senegalese army, are contributing significantly to malaria surveillance. The Senegalese Sugar Company, for instance, conducts systematic screenings for seasonal workers and distributes insecticide-treated nets (ITNs) to truck drivers. Gaston Berger University has also conducted malaria awareness sessions and provided ITNs to students.

The involvement of private and semi-public institutions in malaria detection and documentation has increased considerably since the introduction of BRHS’ performance-based financing model. With this model, health care providers receive a quarterly bonus based on the results of the data verification, according to the documentation rate and the number of malaria cases investigated. Overall, private sector contributions accounted for 47% of documented and notified malaria cases. Large private health service providers, in particular, have shown notable improvements in the timely documentation and notification of cases, thanks to BRHS’ support.

Local Initiatives to Strengthen Case Investigation

With the support of BRHS, district management teams have enhanced the capacity of over 400 health service providers such as doctors and nurses on malaria case investigation procedures and tools, ensuring more than 60% of service delivery points are supervised each quarter. The Saint-Louis Regional Health Directorate also monitors all districts and conducts data quality assessments in partnership with the National Malaria Control Program, BRHS, and the Malaria Control and Elimination Partnership in Africa (MACEPA). Additionally, each health facility, including private ones, now has a focal point for case investigations and a WhatsApp group (established by the districts) to internal streamline communication.

Driven by a strong commitment to eliminating malaria, Saint-Louis district has digitized its supervision and data quality audit tools, marking it as the first district to do this in the region and country. This enables better monitoring of investigation activities in the district, and rapid decision-making if shortcomings are noted. These initiatives reflect the dedication of local stakeholders, with district officials viewing this as a critical step in empowering local actors to lead malaria case investigations.

The Path Towards a Malaria-Free Future

Despite significant progress, several challenges remain for the Saint-Louis region in its quest to eliminate malaria by 2030. These include:

• Enhancing Entomological Surveillance : Introducing advanced technologies such as the LAMP (loop-mediated isothermal amplification) test, which allows for rapid and highly sensitive malaria detection, is essential to better identify high-risk areas and prevent outbreaks.
• Strengthening Malaria Management at the Mauritania Border : Collaborating with administrative authorities to control potential cross-border transmission is crucial to maintaining gains in malaria reduction.
• Mobilizing Domestic Resources : Engaging the Health Development Committee, local communities, and private companies in funding malaria surveillance activities will be key to sustaining efforts in the long-term.
• Ensuring Regular Supply of ITNs and Antimalarials : Keeping health facilities stocked with ITNs and antimalarials will support timely case response and help curb transmission.
• Advancing Genomic Surveillance : Strengthening genomic surveillance capabilities will help in the precise classification of cases.

Nevertheless, the achievements in Saint-Louis highlight the power of a coordinated and collaborative response in accelerating malaria elimination. To maintain this momentum, continued mobilization of local resources will be essential. The region has the potential to become a model for malaria elimination for other regions in Senegal and across West Africa.