Accounting for 29% of all deaths and 42% of deaths in children under five, malaria is considered the most important public health problem in Mozambique. It is endemic throughout the country, and the entire population is at risk.



The floods led to serious malaria epidemics. Plasmodium falciparum is the predominant malaria species responsible for 90% of cases, with other reported species including Plasmodium malaria and Plasmodium oval at 9% and and 1% respectively (MISAU, 2012). The DHS showed a reduction in average malaria prevalence nationally, from 51.5% in 2007 to 38.3% in 2011. The 2011 DHS also showed a reduction in all causes of under-five mortality to 97/1000 from 138/1000 in the 2008 Multiple Indicator Cluster Survey (MICS). In the 2011 DHS, malaria prevalence among children under five years was 46% in rural areas and 17% in urban areas lower than the 2007 MIS in which malaria prevalence among children under five years was 57.8% and 26.5% in rural and urban areas respectively.


 Malaria prevalence is reported to have decreased in all provinces between 2007 and 2011 despite a multitude of administrative and health resource challenges, which have slowed the progress of key malaria prevention and treatment interventions. No nationally representative data on malaria risk is available since the 2001 DHS survey. An MIS took place in 2015. The MoH has introduced DHIS-2 which should facilitate the monitoring of the burden of malaria in coming years. Progress with control is not expected to be homogeneous and it will become increasingly important to detect and understand variations in malaria epidemiology with greater spatial resolution. 


The DHS and other national household surveys are designed to be representative at the provincial level. However, the operational unit for malaria control is the district and ensuring the availability of key information on malaria risk at this level will become increasingly important. As disease risk falls, the efficiency and utility of household surveys to monitor progress with transmission reduction will also fall. At some level of transmission, it will become important to monitor case incidence, and then absolute case numbers. This will depend on the reliable capture and forwarding of data on parasitologically confirmed malaria cases presenting to health facilities. 


The National Malaria Control Programme (NMCP) falls under the Directorate of Public Health within the Ministry of Health in Mozambique. The programme is headed by the director of the NMCP to whom the four thematic unit leads report, as described in the organogram below (Figure 3.1). The individual thematic units are comprised of technical sections that are responsible for managing the relevant interventions. So, for example, ITN distribution is managed by the ITN section under the Vector Control Unit. 



The NMCP is responsible for the coordination of all national malaria control efforts including the planning and mobilisation of funds for the implementation of the National Malaria Strategic Plan, developing and implementing malaria policies and strategies within the SNS and defining national and provincial targets for malaria indicators. The NMCP defines priorities and activities for each implementation area in a five-year strategic plan, which is then broken down into annual work plans. The NMCP is responsible for monitoring and evaluation of progress in malaria control in Mozambique as well as having oversight of all malaria research activities and surveys.


Since 2012, the Mozambique malaria programme has not been fully resourced. Based on the malaria strategy 2012-16 (an updated strategy was created for 2014-16 with minimal changes in activities – therefore original cost assumptions are presumed valid), resource requirements on an annual basis vary from US$ 85 million to US$ 124 million, with an average cost of US$108 million. Beyond GoM funding, the NMCP receives funding, primarily, from two donors – the PMI and GFATM. Over a continuous period of five years (2009-2013), the PMI contributed an average of US$ 26 million, GFATM contributed an average of US$ 11 million, and other donors contributed smaller amounts totalling an estimated US$ 6 million per year. 


Based on current trends, the PMI and GFATM will account for an average of 78% of total funding from 2012 to 2017. Smaller contributions have been made by UNICEF, DFID, Spain, the Netherlands, and WHO (MISAU, 2014) The PMI commitment to Mozambique for FY 2015 was US$ 29 million. Under the GFATM Round 9 Phase 2, Mozambique was awarded US$ 92.4 million for malaria over five years and is eligible for a further US$ 6 million over 2.5 years under the GFATM new funding model (NFM), which was approved in June 2015. 


Between 2004 and 2014, the GFATM has disbursed a total of US$ 160,403,600 to Mozambique for malaria. In 2014, the “la Caixa” against Malaria project was launched jointly by “la Caixa” Foundation and the Gates Foundation with the aim of eliminating malaria in southern Mozambique by 2020. The programme is being implemented by the Barcelona Institute for Global Health (ISGlobal) and the Centro de Investigação em Saúde de Manhiça (CISM - Manhiça Health Research Centre) with the participation of other partners and under the leadership of the Ministry of Health.


The Clinton Foundation began malaria projects directly implemented by the Clinton Health Access Initiative (CHAI) in 2015, through a five-year Gates grant, with a focus on preelimination areas around the country in partnership with CISM. In August 2015, ministers of health from Mozambique, South Africa and Swaziland signed an agreement to ensure that the malaria control fraternity from each of the countries support the development of infrastructure and expertise in southern Mozambique in order to lower the prevalence of the disease in the border regions of these countries. This initiative, MOSASWA (Mozambique, South Africa & Swaziland), will try to emulate the Lubombo Spatial Development Initiative, which ended in 2011.