South Africa

Elimination Target Year

Country Overview

  • 10% of this population live in areas of active transmission (Total population 52.98 million)
  • South Africa has reached a stage where elimination is possible by 2020, with the province of Kwazulu Natal likely to achieve malaria elimination first. Approximately 77% of malaria cases are diagnosed in travelers from neighbouring countries each year (imported cases).


South Africa achieved a substantial decline in malaria cases, from 64,624 in 2000 to 5775 in 2016. During the same period, malaria-related deaths decreased from 424 to 42. Due to a long history of successful malaria control efforts, malaria transmission in South Africa is now confined to three endemic provinces (provinces where malaria is regularly found and reported) in the north and northeastern parts of the country, namely: Kwa Zulu Natal, Limpopo, and Mpumalanga. Malaria transmission in South Africa is seasonal, with most cases occurring during the rainy summer months of September through May, and peaking in January and April.

The National Department of Health, working through provincial implementation structures, WHO and other partners, is guiding a malaria elimination strategy to achieve malaria elimination by 2018.

Focus on the End Game

The malaria burden in South Africa varies greatly by province. Limpopo Province reports 62% of local cases, while Mpumalanga accounts for 32% and KwaZulu-Natal province 6%. Key objectives outlined in the National Malaria Elimination Strategy 2012–2018 include:

  1. To strengthen passive and active surveillance, and monitoring and evaluation systems, so that 100% of districts report promptly and routinely on key malaria indicators by 2016
  2. To ensure that all levels of the malaria programme have a core team to coordinate and implement elimination interventions by 2016
  3. To disseminate appropriate messages so that 100% of the population has sufficient knowledge to influence their attitude and practice on malaria by 2018
  4. To effectively prevent local malaria infections and eliminate parasite reservoirs in 80% of the malaria endemic districts in South Africa by 2018

Key Challenges

  • Prioritizing Malaria in the face of competing health priorities: An estimated 6.4 million South Africans are living with HIV/AIDS and over 60 percent are co-infected with tuberculosis, thus, maintaining policy focus and adequate resources for malaria elimination is a constant challenge
  • Foci-Clearing: There has also been significant progress in implementing foci clearing initiatives in the endemic areas. This has been made possible through deploying surveillance units that track and follow-up on any local cases while working in partnership with a team of Entomologists to clear any identified breeding sites. The limited human resources in the entomology team has somewhat limited their geographical coverage.
  • Importation: Increased and frequent population movement across South Africa’s borders in recent years makes malaria elimination very difficult. Cross-border initiatives to strengthen prevention in the exporting areas of neighbouring countries and to provide treatment services to migrant populations are being rolled out and expected to result in further declines, towards zero by 2018

Key Statistics

Recorded Malaria Cases

Recorded Malaria Deaths

Malaria Incidence Rate