Sri Lanka has made extraordinary progress in eliminating malaria, reducing cases from over 500,000 in the early 20th century to just 17 reported cases in 2015. However, malaria elimination faces ongoing challenges, as imported malaria from travelers and migrants is increasing. Sustaining malaria elimination requires continued vigilance, such as ensuring all cases are properly treated according to guidelines, conducting case investigation and response, and preparedness for potential outbreaks. Cooperation with neighboring countries is also important to address the ongoing risk of imported malaria hampering elimination efforts.

1. Risintha Premaratne a and Dr Ben Rolfe b
a Director, Anti Malaria Campaign, Ministry of Health
b Executive Secretary – Asia Pacific Leaders Malaria Alliance
Cold Chain Management
during MR Vaccination
Campaign 2014
Asia Pacific 2030 Elimination
Experience from Sri Lanka

2. Malaria incidence in Sri Lanka, 1911-2015 (to date)
17 cases
11 imported
500,000 700,000
ZERO
Jungle clearing
Cleaning of channels
Filling of small pools
Application of mineral oils
Use of larvivorous fish
Prophylactic quinine
Funding Declines
DDT Scaled down
Spray teams disbanded
Microscopy declines
82K Deaths
Now an
international
relations
issue
vigilance
units
Dam
construction
and irrigation

3. 7 January 2016
0
200
400
600
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
ReportedMalariaCases(x1000)
Malaria in Sri Lanka - why
the decline?
• Better application of control strategies?
• Research inputs ?
• More evidence based approach to control?
• Decentralisation?
• Stability, improved administration?
• Social and economic advancement of people?
• Natural causes ?
- environmental change?
- change in species complex of An.culicifacies?
?
Sustaining disease control when the
incidence is low
• Allocation of health budgets
• Skills and competencies
Did GFATM funds help to prevent a

4. 7 January 2016
0
10
20
30
40
50
60
2001 2002 2003 2004 2005 2006 2007
ReportedMalariaCases(x1000)
GFATM
Round 1
7.25 mi USD
GFATM
Round 4
3.69 mi USD
Malaria in Sri Lanka

5. An extraordinary achievement

7. Challenges

8. There is a risk of Resurgence
• High Receptivity:
– Suitable temperature and humidity. Breeding places: paddy
cultivation, irrigation wells, quarry pits, sand pools
• High Vulnerability:
– Migration, development projects need malaria impact assessment.
– Unstable, seasonal malaria, prone to explosive epidemic.
– Increasing inward migration, tourism etc.
A foreign policy issue…

11. Challenges to malaria elimination
 Imported malaria is increasing
 Armed Force personnel acquiring infections while on
UN peace-keeping missions
 Deported Sri Lankans from malaria-endemic countries
 Irregular / “illegal” migrants
 Travelers (local & foreign) to & from malaria-endemic
countries
 Rare disease events leading to malaria
becoming a “forgotten” disease
11
Risintha Premaratne * Anti Malaria Campaign
Ministry of Health

12. An impressive response
Ongoing effort is required,
with significant positive
externalities

13.  Ensure all diagnosed cases are treated as per
national treatment guidelines
 Sustain case investigation and response
 Ensure outbreak preparedness, prevention and
response
 Engaging the private sector in case
management and surveillance
 Work with neighbors on case importation
Ongoing Priorities:

14. Cluster of vivax malaria among asylum seekers
Over 1000 immigrants screened
23 cases identified and Regular screening continues
Thank you…