Story from the Field: South Africa Uses Microstratification to Drive Toward Malaria Elimination

In the far north-east of South Africa, malaria once returned quietly with every rainy season. Communities in border areas of KwaZulu-Natal, close to Mozambique and Eswatini, faced recurring fever, illness and uncertainty. For frontline health workers, it was often difficult to predict which villages would be affected next.

Today, that picture is changing.

Through microstratification - the use of detailed local data to identify and respond to malaria risk at community level - South Africa is sharpening its malaria response and accelerating progress toward elimination.

This country-led, data-driven approach reflects the spirit of World Malaria Day 2026: "Driven to End Malaria: Now We Can. Now We Must."

Seeing malaria more clearly

Rather than treating entire districts as having the same level of risk, provincial and national malaria teams are analyzing surveillance data, case investigations and geographic trends to pinpoint smaller areas where transmission persists.

Sometimes these hotspots are limited to only a few villages or settlements. By identifying exactly where malaria risk is concentrated, health authorities can deploy interventions with greater precision and impact.

Delivering the right response at the right time

Microstratification has helped South Africa target resources where they are needed most.

In higher-risk communities, indoor residual spraying campaigns are intensified before the rainy season. Surveillance teams investigate confirmed malaria cases rapidly and screen nearby households to detect additional infections early. Communities are also playing a central role by reporting symptoms quickly, supporting spray operations and helping protect households from mosquito bites.

This combination of timely action, strong surveillance and community partnership is helping interrupt local transmission.

Results that matter

The impact has been significant.

Across South Africa's most malaria-endemic provinces - KwaZulu-Natal, Limpopo and Mpumalanga -malaria cases declined from 14 817 in 2015 to 3 602 in 2025, representing an estimated 75% reduction in this period. The decline is on track with the WHO Global technical strategy 2015-2030 target.

An increasing share of malaria cases (around 78%) detected in the country are now imported infections rather than locally acquired cases - an important milestone on the pathway to elimination.

A model for precision public health

The national malaria programme South Africa supported by its surveillance malaria elimination committee (SAMEC) experience shows how precision public health approaches can maximize impact, especially when resources are limited. By focusing on the right places, at the right time, with the right interventions, programmes can protect vulnerable populations more effectively.

Microstratification is also strengthening cross-border collaboration with neighboring countries, recognizing that malaria does not stop at national boundaries.

Now we can. Now we must.

WHO's World Malaria Day 2026 campaign highlights that science, innovation and nationally led programmes are bringing a malaria-free future within reach.

On this World Malaria Day 2026, Ms Ednah Baloyi, Director of the National Malaria Programme, South Africa emphasized that "Ending malaria is within reach, but only if we sustain investment and embrace innovation. In South Africa, scaling up new tools, strengthening vector control, and investing in high impact interventions will ensure that 'now we can' truly becomes 'now we must".

Ms Shenaaz El-Halabi, WHO Representative in South Africa highlighted that "In South Africa, significant strides have been made towards malaria elimination, supported by targeted interventions and enhanced surveillance…While progress is evident, challenges remain. Funding gaps, insecticide and drug resistance, climate variability, and population movement all threaten to reverse gains if vigilance is not maintained."

As South Africa works toward its national malaria elimination goal, its progress offers a clear lesson: when data guides action and communities are empowered, malaria can be stopped.

South Africa's journey is a reminder that the tools exist, progress is possible, and with sustained commitment now we can - and now we must - end malaria.