INTERVIEW: Cabo Verde Health Minister Explains Country’s Path to Malaria-Free Status

In a significant breakthrough for public health, Cabo Verde, the archipelago off the northwest coast of Africa, was declared malaria-free by the World Health Organization on January 12.

With a decline in malaria risk, Cabo Verde emerges as an attractive haven, offering not only a pristine landscape but also a healthier environment for tourism, aligning with the evolving preferences of travellers who may raise concerns about mosquito-borne disease.

With the aim of open knowledge sharing, FIJ had an interview with Filomena Gonçalves, Cabo Verde’s minister of health.

Can you explain the specific strategies and interventions that Cape Verde employed to reach the milestone of becoming malaria-free?

Cape Verde’s path to eliminating malaria has been long. It received a boost with the inclusion of this objective in its national health policy in 2007. A strategic plan for malaria from 2009 to 2013 laid the foundation for success, focusing on broad diagnosis, early and effective treatment, and notification and investigation of all cases. To stem the tide of imported cases, diagnosis and treatment were provided free of charge to international travellers and migrants.

In 2017, the country turned an outbreak into an opportunity. Cape Verde identified the problems and introduced improvements, which led to zero indigenous cases for three consecutive years.

Collaboration between the Ministry of Health and various government departments focusing on the environment, agriculture, transport, tourism, etc., has played a key role in Cape Verde’s success. The inter-ministerial commission for vector control, chaired by the prime minister, was fundamental to the elimination. The collaborative effort and commitment of community organisations and NGOs demonstrates the importance of a holistic approach to public health.

How crucial were partnerships, both national and international, in efforts to eradicate malaria, and what role did they play in the success of the initiative?

The mobilisation of national and international technical and financial resources was important in strengthening technical capabilities and in the development and implementation of malaria elimination activities through standardised operational procedures in the different areas.

Are there any innovative or unique approaches that Cape Verde has adopted in the fight against malaria that you believe could be applicable or adapted in other regions facing similar challenges?

The elimination of malaria occupies a preponderant place in the national development agenda, as expressed in the country’s national health policy, which established the achievement of this objective by 2020 and responds to the Sustainable Development Goals (SDGs) and global and regional guidelines.

An inter-ministerial commission to combat vectors that transmit malaria and other diseases transmitted by mosquitoes exists and is chaired by the prime minister. It is made up of government members, whose mission is to approve the National Anti-Vector Control Plan, coordinate the entire process, combat conditions favourable to the outbreak and multiplication of disease vectors, and control epidemics caused by these vectors and provide the necessary resources to minimise the impact.

At the central level, there is a multi-sectoral anti-vector control commission made up of general directors from different ministries, municipal councils and community associations that participate in the preparation and implementation of a national plan to combat mosquitoes.

At a decentralised/municipal level, there is a municipal health commission that incorporates the different municipal delegations in the implementation and execution of municipal plans to combat mosquitoes.

Maintaining a malaria-free status requires continued vigilance. What sustainable practices and surveillance mechanisms has the Ministry of Health established to prevent the resurgence of malaria in Cape Verde? This question arose from my conversations with tourists and citizens who fear that this achievement may be short-lived.

The country has strategic plans for the elimination and prevention of the reintroduction of malaria that are being implemented.

In the process of eradicating malaria, were there any unexpected challenges or obstacles faced by the ministry of health? How were they addressed?

There were recommendations from the WHO team, and they were implemented, namely in the development and implementation of standardised operational procedures for epidemiological and entomological surveillance, in the fight against vectors, in the diagnosis of malaria, in case management, in the malaria quality control laboratory and in strengthening the training of health professionals in different areas.

As a country that has successfully eliminated malaria, what advice or recommendations would you give to other nations aspiring to achieve the malaria-free status? 

For Cape Verde, political stability and the strong commitment of governments to eliminating malaria were fundamental and they were a national goal.

The elimination of malaria occupies a predominant place in the national development agenda, as expressed in the country’s national health policy, which established this objective.

The re-qualification of areas identified as hot spots for malaria, namely the Fontão area in the Municipality of Praia, the drainage of rainwater in different localities and neighbourhoods on different islands (Santiago and Boa Vista) classified as high risks for the reintroduction of malaria disease, contributed significantly to the elimination of autochthonous cases.

There was also greater support for the integration of activities to combat malaria in a decentralised manner through health stations at the municipal level

Can you share insights into the monitoring and evaluation framework used to evaluate the impact of malaria control programmes and how data-driven decision-making contributed to overall success?

The country has strategic instruments: Strategic Malaria Elimination Plan 2020–2023, Malaria Reintroduction Prevention Plan 2023–2025, an efficient epidemiological surveillance system adjusted to different epidemiological strata and case management across the entire health service network; 100% of the proportion of suspected cases confirmed by thick gout; the case notification rate, within a maximum period of 24 hours; the case investigation rate, within a maximum period of 48 hours, at 100%; 100% outbreak investigation and response rate within a maximum period of 7 days; 100% of malaria cases cured, followed up on an outpatient basis until the 28th day, an efficient entomological surveillance system adjusted to different epidemiological strata and strengthening the quality of vector control interventions; vector sensitivity tests to the insecticides used or to be used; study plan for the sensitivity of the vector to insecticides and the bio-efficacy of the insecticides used; 80% of houses sprayed with a remaining action insecticide.

How does Cape Verde ensure the sustainability of its status as a malaria-free country, considering factors such as climate change, migration and the potential introduction of malaria from neighbouring regions? Citizens and tourists alike have raised concerns about what checks are implemented at airports and other points of entry into Cape Verde.

With the implementation of an active surveillance system throughout the year. There is an anti-vector control team in health departments, which carries out programming activities to combat adult mosquitoes and monitor breeding sites with the systematic application of larvicides, biological control with larvivorous fish and environmental management.

A team of health inspectors also travels to airports in accordance with the flight schedules of endemic countries with the aim of screening and informing passengers, in case of symptoms, to go to the nearest centre and confirming the disinsection of aircraft coming from malaria-endemic areas. The same procedure applies to ports.

Looking ahead, what future initiatives or collaborations is the ministry of health planning to undertake to further strengthen the country’s healthcare system and prevent the reintroduction of malaria?

For the malaria elimination programme, the country has relied on regular funding from the government, through the general state budget, but also on funding for anti-vector control actions developed by municipal councils in its territory.

The government of Cape Verde, together with the Global Fund, from 2023, has assumed progressive co-financing for malaria, with the mobilisation of resources to finance the existing deficit, for the period of implementation of the Malaria Reintroduction Prevention Plan.