Table 5 Additional challenges for elimination and intensified control.

I. Community and household

Reduced acceptability of control measures such as house spraying as perceived malaria risk falls; acceptability of new interventions such as mass screening and treatment; changed behavioural response to illness as age distribution of malaria changes and malaria share of fevers declines; access barriers to reaching isolated (geographically, socially, etc.) communities for outbreak control

II. Health service delivery

Need for effective disease surveillance and response systems

III. Health sector policy and strategic management

Strengthened links between technical programmes (e.g. malaria and MCH programmes) to ensure revised guidance for appropriate management of non-malaria fever and greater burden of disease in adults

IV. Public policies cutting across sectors

Legal frameworks and border controls for coordinating action in cross-border outbreaks; financing mechanisms that allow for and protect commitments to malaria control

V. Environmental and contextual characteristics

Ensuring sustained political and financial commitment to eradication at all levels; structures of public accountability that will support such commitment