Abstract:
BACKGROUND : Malaria continues to be a public health problem in South Africa. While the disease is mainly confined
to three of the nine provinces, most local transmissions occur because of importation of cases from neighbouring
countries. The government of South Africa has reiterated its commitment to eliminate malaria within its borders. To
support the achievement of this goal, this study presents a cost–benefit analysis of malaria elimination in South Africa
through simulating different scenarios aimed at achieving malaria elimination within a 10-year period.
METHODS : A dynamic mathematical transmission model was developed to estimate the costs and benefits of malaria
elimination in South Africa between 2018 and 2030. The model simulated a range of malaria interventions and
estimated their impact on the transmission of Plasmodium falciparum malaria between 2018 and 2030 in the three
endemic provinces of Limpopo, Mpumalanga and KwaZulu-Natal. Local financial, economic, and epidemiological
data were used to calibrate the transmission model.
RESULTS : Based on the three primary simulated scenarios: Business as Usual, Accelerate and Source Reduction, the
total economic burden was estimated as follows: for the Business as Usual scenario, the total economic burden of
malaria in South Africa was R 3.69 billion (USD 223.3 million) over an 11-year period (2018–2029). The economic burden
of malaria was estimated at R4.88 billion (USD 295.5 million) and R6.34 billion (~ USD 384 million) for the Accelerate
and Source Reduction scenarios, respectively. Costs and benefits are presented in midyear 2020 values. Malaria
elimination was predicted to occur in all three provinces if the Source Reduction strategy was adopted to help reduce
malaria rates in southern Mozambique. This could be achieved by limiting annual local incidence in South Africa to
less than 1 indigenous case with a prediction of this goal being achieved by the year 2026.
CONCLUSIONS : Malaria elimination in South Africa is feasible and economically worthwhile with a guaranteed positive
return on investment (ROI). Findings of this study show that through securing funding for the proposed malaria interventions
in the endemic areas of South Africa and neighbouring Mozambique, national elimination could be within
reach in an 8-year period.
