Intensified malaria surveillance, good health governance and policy, community engagement and operational research have been spotted as key missing links that led to halting of the malaria eradication campaign. The pre malaria eradication prevailing WWII view that “malaria control shouldn’t be a campaign. It should be a policy, a long-term program. It cannot be accomplished or maintained by spasmodic efforts. It requires adoption of a practical program, the reasonable continuity of which will be sustained for a long-term years” (Boyd, M.F. (1939) has proven relevant and is still valid in Burundi. Failure to learn from the past means that history is likely to repeat itself.
Over the past five years corresponding to the national malaria strategic plan 2013-2017, whereas many countries in Africa have witnessed improvements in malaria morbidity and mortality, malaria incidence in Burundi has steadily increased and has indeed skyrocketed between 2014 and 2017, when reported incidence rose from 425/1000 in 2014 to 815/1000 at risk population in 2017, a near two-fold increase. A malaria outbreak was only officially declared in March 2017. The official declaration paved the way to the initiation and implementation of a multi stakeholder response under the leadership of the Ministry of Public Health and HIV/AIDS, with support from WHO, USAID, the Global Fund, the World Bank and other Partners. The outbreak was brought under control and declared over in December 2017. Reported incidence has continued to decline, but a closer look at the core areas of focus related to lessons learned from eradication era highlights systemic deficiencies in malaria surveillance, early warning and response, weak community engagement, and outdated malaria policies, as well as lack of collaboration with research institutions.
In-depth policy reviews are needed in order to revolutionize malaria control efforts towards a successful transition to malaria elimination.