El Salvador on the path to being malaria-free

With zero reported indigenous malaria cases since 2017, El Salvador is on the path to achieving official malaria-free certification by WHO. This small country has made great strides by ensuring that all malaria cases are treated and reported.

The rapidity and durability of El Salvador’s malaria decline is especially notable in comparison with its immediate neighbors Guatemala and Honduras, with whom it shares a similar climate, malaria vector characteristics, and topography (in areas of ongoing transmission). Until the early 1980s all three countries experienced similar cyclical patterns of malaria transmission, but in 1981 El Salvador’s malaria trajectory began to diverge. A period of rapid decline in the 1980s and 1990s has been followed by two decades in which malaria incidence has been kept at very low levels.

As early as 1990, El Salvador introduced an electronic malaria information system to allow for the targeting of malaria interventions to specific geographies and populations. The country is also working to ensure all of its cases are 100% verified and confirmed through quality diagnostic testing. As a neighbor of malaria-endemic Guatemala and Honduras, El Salvador is strengthening malaria surveillance along international borders; this includes developing a strategy for detecting suspected malaria cases among immigrants who may already be working in the country.

El Salvador’s malaria elimination programme is supported by 3 pillars: strong political engagement backed by sustained domestic financing; a multi-sectoral national strategic plan that is data-driven; and ongoing education about malaria for everyone – from clinicians to community members.

To be on track, El Salvador needs to increase efforts to address migrants’ and mobile populations’ vulnerability to malaria. The threat of malaria importation is a significant challenge; the country is home to many immigrants seeking employment opportunities and also serves as a crossroads for those heading further north. In addition, the country needs to ensure that surveillance efforts are maintained in communities through the continued engagement of community health volunteers and health promotion agents in health facilities.

El Salvador provides a relevant country case study, as learnings can guide application of similar elimination strategies in the Mesoamerican region and beyond.