Mozambique: An Exemplar in Malaria Subnational Tailoring

Mozambique is among the countries with the highest malaria burden in the world, with an estimated 2023 case incidence rate of approximately 442 cases per 1,000 people, one of the highest in Africa. Although the entire country is considered at risk, rates of malaria transmission and prevalence are highly variable across provinces and districts, with higher risk in the northern and coastal zones. Consequently, in recent years, the country has moved away from a “one-size-fits-all” malaria response and toward an approach known as subnational tailoring (SNT), which uses granular local data to customize malaria interventions to specific geographic, entomological, socioeconomic, and climate conditions.

With the support of technical partners, local leaders, and actors at all levels of the health system, Mozambique has used several promising practices for SNT implementation, including:

• Strong national leadership and multilevel coordination that enabled coherent SNT implementation at all levels of the health system.

• A culture of data and evidence generation that supported the continuous refinement and adaptation of interventions.

• Stakeholder engagement at the local level facilitated increased ownership and accountability.

• Investments in innovative data systems and infrastructure that strengthened data quality, integration, and availability for evidence-based decision-making.

Despite funding gaps, insecticide resistance, and climate shocks, Mozambique has made meaningful progress in malaria control: for instance, national malaria parasite prevalence declined from 40% in 2015 to 32% in 2023. Consequently, the country offers a model for evidence-based malaria program decision-making in similar high-burden settings.