Interview with Dr. Joseph Mberikunashe: The path towards malaria elimination in Zimbabwe

Q: How did you start your career in malaria?
A: I am a public health specialist by training. After medical school, I went to the provinces and district hospitals, and eventually found myself working in the National Malaria Control Program in 2007. It (malaria) was always interesting for me, along with TB and HIV. I discovered it was a great opportunity and very much needed in my country.

Q: Can you give a brief history of malaria in your country?
A: Malaria used to be the number one cause of hospital attendance especially during the rainy season, which starts about November every year and goes to May. About 50% of Zimbabwe's population resides in malaria receptive areas. Most of those people do not have immunity. We used to record between 2-3 million cases per year (in early 2000s), but over the years there has been a significant decline to less than 500,000 per year. Deaths have also declined from 300,000 to now less than 400 per year.

Q: What are your major challenges?
A: The first is the timing of outside funding, which can be a challenge. Malaria timing is seasonal and if you don't get your disbursements in time, it can be a challenge. A second challenge deals with cross border complexities. We are a landlocked country - sharing a border with Zambia and Mozambique, and low transmission countries of Botswana and South Africa. Where we border with Mozambique, there is intense transmission and movement of people. Mosquitoes know no borders! We become very interdependent on them in terms of interventions – if we spray and they don't spray, that is a problem. They may have different priorities. Of course, because of population movements, people tend to seek medical help at facilities nearest to them. Even if we try to do prevention on our side, as long as our neighbors in Mozambique are not protected and they find easy access to facilities on our side, we will continue to have cases. So we need to work together.

Q: How can global initiatives such as the Global Fund and regional initiatives like the Elimination 8 (E8) support your country?
A: We have cross border initiatives with our neighbors – MOZIZA (Mozambique, South Africa and Zimbabwe), a Zimbabwe-Zambia Initiative supported by the Global Fund, and we have the E8, which includes eight Southern African countries (Angola, Botswana, Namibia, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe). The E8 now has developed a strategic plan that goes until 2025. We will be costing out the plan, and it includes aspects that are regional such as surveillance, data sharing, how to deal with mobile populations. We believe that if partners buy in to the strategic plan, it would be very useful.

Q: What do you think is the most important element needed for your country's elimination success? Are you optimistic that you will achieve elimination?
A: I am very optimistic! There are two main aspects. The first and most important thing is to not lose the gains that have been achieved. Malaria resurgence is very possible. The second is the issue of cross-border transmission. That has to be addressed and is crucial. You can do so much for many years and not achieve elimination as long as your neighbor has many cases. We need to collaborate with our neighbors.

Just for fun:

Q: What is your favorite place in your country?
A: Victoria Falls!