Key decisions and action have been taken by the Government of Mozambique to control malaria during the last 35 years. Efforts have intensified over the last 15 years as the government, along with internal and external partners worked to achieve the Millennium Development Goals. This section attempts to capture key initiatives across the main intervention areas. Fever-related hospital admissions were a huge burden on the population in the early 1900s, and were largely attributed to malaria. The highest proportion of malaria cases was in Lourenço Marques province. Between 1901 and 1920, a drop in the prevalence of malaria was documented across the country. In Lourenço Marques, the prevalence fell from 61% in 1901 to 30% in 1920. These changes were attributed to petrolage of the swamps and drainage and levelling of marshes, typical breeding sites for the mosquito vectors (Soromenho, 1923).





This initiative began the sub-division of the city into urban, sub-urban and rural locations for vector control efforts, which focused on larval control, delivered by “sanitary police”. Malaria control continued to focus on vector control activities up to 1970, with the continued use of larviciding and the introduction of IRS usuing DDT, gammexane and dieldrin. Selection criteria of areas for vector control activities included provincial capitals and their suburbs largely due to population concentrations and economic activities. Between the mid-1940s and the late 1970s, there were also reports of the national use of chloroquine (CQ) or proguanil as prophylaxis in school children as documented by Schwalbach and De la Maza (1985). With the advent of the civil war, malaria control in Mozambique came to a halt between the mid-1970s and early 1990s. In 1982, the Programa nacional de controlo da malária, the NMCP, was re-established and limited malaria control activities were carried out within Maputo city.


With the beginning of the Roll Back Malaria (RBM) partnership in 1999, African Heads of States commited to fight malaria and its effects on the workforce and economies, and to dedicate an appropriate share of their national budgets to health. In 2013, the Mozambique government allocated 9% of its expenditure to health.


The Lubombo Spatial Development Initiative (LSDI), a tri-lateral initiative between the governments of South Africa, Swaziland and Mozambique aimed to accelerate the agricultural and economic development of the Lubombo Mountains region, which straddles the three countries. Malaria was identified as one of the main threats to the success of the initiative, with large parts of the region classified as endemic or seasonally endemic and a high incidence of severe malaria caused by Plasmodium falciparum.


 The loss of productivity associated with malaria morbidity and mortality, in conjunction with the high cost of treatment and control of the parasite and its vectors, contributed to economic and social decline and a lack of development in the region. The need for a regional, inter-country approach to fight malaria led to the establishment of the Lubombo Malaria Control Programme in October 1999 through the signing of the Malaria protocol of understanding at ministerial level between the three countries. The purpose of the control programme was to address crossborder issues of population, parasite and vector movements, as well as the development and spread of vector and parasite resistance. The project started in Mozambique in 2000 with a focus on four project zones within Maputo province.


 The LSDI project was a show-case for successful public private partnerships (PPP) in malaria control, with funding from the private sector (notably BHP Billiton) and with government contributions from 2003. The majority of funds for the programme from 2003 onwards were provided by the GFATM, with additional inputs from an array of private and public partners (Laas, 2012). With greater support from the wider malaria community, and more data available from the MDHS of 1997 and 2003, the period 2001-2010 saw renewed efforts from the NMCP. 


The focus of vector control activities continued to be around the colonial rationales of prioritising provincial capitals and suburbs, with some expansion based on annual malaria incidence. Emerging resistance to pyrethroids (lambda-cyhalothrin) and carbamates (bendiocarb) motivated timely replacement of insecticides for IRS, often reverting back to DDT. The LSDI project expanded to cover all of Maputo province and Gaza province in 2006. Changes in first line treatment were also made, moving from SP monotherapy to AQ-SP as the interim policy in 2002, followed by AS-SP as first line in 2006 and to AL in 2009.


The PMI support from 2007 allowed IRS to be scaled up alongside comprehensive malaria control support – consisting of LLIN distribution via ANC, APE, procurement and distribution of RDTs and ACTs, and procurement and distribution of SP. Manhiça became one of the global malaria vaccine trial sites through CISM. The second national malaria strategic plan covering 2006-2009 was developed. 


Between 2011 and 2015, the third National Malaria Strategic Plan (2012-2016) helped to coordinate concerted efforts to control malaria. Distribution of LLINs expanded to areas that had previously not received nets and net replacement was prioritised. The period 2011-2014 saw large-scale coverage across the country with ITNs, with a total of 12 million nets delivered via mass campaigns and another five million distributed through ANCs.