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By Michael Adekunle Charles
Last December in Juba, I walked through the wards of Al-Sabbah Children’s Hospital and saw the same story on every small face: malaria. It was the quiet diagnosis for almost every child receiving treatment that morning. “It’s about 80 percent of what we see,” a health worker told me, the strain evident as they marshaled limited tools to save lives in a country hardened by conflict.
When a nation is gripped by conflict, its government must wear the crucial hat of resilience and hope. As the RBM Partnership joined South Sudan to launch the High Burden High Impact (HBHI) Initiative in early December, the government emphasised its commitment to rewriting its story and that of its people—starting by rebuilding health systems so that the human capital needed to rebuild the nation remains alive and healthy.
A vital part of this new health story is strengthening the malaria response. The HBHI initiative represents an important step for countries in recognising that they carry a disproportionate burden of malaria—a burden that impedes health and development. HBHI is a critical first step in addressing malaria’s specific impact on all facets of life and the economy.
A report by RBM partners, Malaria No More UK, and the African Leaders Malaria Alliance, indicates that if we stay on track to meet our 2030 targets, we can save 1.86 million lives and boost Africa’s GDP by US$231 billion. Conversely, a worst-case scenario—where the world turns its back on the fight, and countries cannot implement preventative interventions—would cost Africa US$402 billion.
Undoubtedly, conflict-affected countries, where health commodity pipelines are fragile or non-existent, and resources are already scarce, would be the hardest hit by reductions in malaria funding. While the recent Global Fund replenishment shows some promise, having secured over US$11 billion, we remain far from the US$18 billion target needed for malaria.
Furthermore, the funding gap in global health remains a stark reality. According to the 2024 World Malaria Report, total funding for malaria reached US$3.9 billion. This is less than the US$4 billion invested in 2023 and far short of the US$9.3 billion needed in 2024 to reach global targets. The 2024 investment represents only 44 percent of the required funding, leaving a US$5.4 billion shortfall. In 2023, against a target of US$8.3 billion, the US$4 billion invested resulted in a US$4.3 billion gap—meaning malaria received only 48 percent of the required funding. The leap in the funding gap from US$2.6 billion in 2019 to US$5.4 billion in 2024 signals a worrying shift in donor priorities away from malaria and global health.
During the HBHI launch, South Sudan’s Vice President in charge of the Service Cluster, H.E. Josephine Lagu, echoed the RBM Partnership’s call for strong collaboration to turn commitment into action. Acknowledging the realities of the global health funding landscape, she committed to intensifying domestic resource mobilisation to create a more sustainable health response. She announced that the government will work toward establishing an End Malaria Council in South Sudan, joining a growing number of African leaders demonstrating the political will to mobilise domestic resources for malaria elimination.
In South Sudan, donors such as the World Bank and the European Union remain committed to prioritising malaria. Sustaining this commitment and collaborating with the government to mobilise domestic resources is essential for success. The latest World Malaria Report shows that 610,000 people died from malaria in 2024—down from 697,000 in 2023. However, there were 282 million reported cases worldwide, nine million more than in 2023.
As in 2023, Africa bore 94 percent of malaria cases and 95 percent of deaths—a continent that also ranks low on the development index. Five countries—the Democratic Republic of the Congo, Ethiopia, Mozambique, Nigeria, and Uganda—contributed more than half of all global cases. Nigeria registered nearly 700,000 cases, the highest globally, followed by the Democratic Republic of the Congo and Uganda.
The World Health Organization recognises that growing threats of antimalarial drug resistance and insecticide resistance stand in the way of progress in South Sudan. Malaria is the leading cause of patient morbidity there, accounting for around 67 percent of all cases and 50 percent of deaths. In conflict settings, where some areas are unreachable and many deaths occur silently at home, the scale of malaria mortality is not fully captured in official statistics. The actual numbers are higher.
The destabilisation caused by conflict creates a perfect environment for malaria and other diseases to thrive, leaving the health system as one of its major casualties. In South Sudan, the perfect storm of conflict, biological threats, and limited funding plays out starkly, necessitating a combined and rapid response to avert deaths. Erratic climate patterns only fan the flames—with parts of South Sudan reporting flooding and higher malaria cases, while others endure extreme temperatures that create ideal breeding conditions for mosquitoes. In complex situations, malaria blooms in unique and dangerous ways.
This is why our approach to malaria in these settings must be as deliberate and nuanced as the realities on the ground. As we move toward implementing Unity 30—RBM’s new framework to unite countries in ending malaria within the next five years, we must mobilise resources for a decisive push against malaria in complex situations and strengthen partnerships to reach our goals faster.
Dr Michael Adekunle Charles is the CEO of the RBM Partnership to End Malaria.
