El Salvador Strengthens Its Health System to Prevent the Reestablishment of Malaria With IDB Support

Zero locally transmitted cases since 2018, 100% timely treatment, and improvements in diagnosis and supply availability reflect progress under the Regional Malaria Elimination Initiative

SAN SALVADOR — With technical and financial support from the Inter-American Development Bank (IDB), through the Regional Malaria Elimination Initiative in Mesoamerica and the Dominican Republic (RMEI), El Salvador continues to consolidate its capacities to prevent the reestablishment of malaria after being certified malaria-free by the World Health Organization in 2021.

Although the country has reported no locally transmitted cases since 2018, the risk of reintroduction persists due to imported cases — four in 2021, one in 2022, and seven in 2023 — within a regional context where transmission remains active. In this scenario, sustaining elimination depends on the strength of surveillance, diagnosis, and response systems.

The results of the first verification of targets conducted under RMEI’s results-based financing model show concrete progress. One hundred percent of confirmed cases assessed in this phase received appropriate treatment within the first 24 hours after diagnosis, in accordance with national guidelines. In addition, all case investigations met quality standards, demonstrating the system’s capacity to respond promptly to imported infections.

In terms of institutional strengthening, the availability of supplies and equipment for malaria diagnosis and treatment increased from 20.8% of health facilities at baseline to 73.9% in the most recent measurement. Improvements were also recorded in the availability of microscopy equipment, reagents, and essential materials across the laboratory network, reinforcing national diagnostic capacity.

The evaluation identified areas requiring further consolidation, particularly in passive surveillance and systematic reporting. Fully 46.2% of facilities met preparedness criteria for the passive detection of suspected cases, and 15.8% of the evaluated units submitted surveillance reports in accordance with established standards. These findings have informed the technical dialogue between the Ministry of Health, the IDB, and PAHO, the technical partner of RMEI, to prioritize strengthening actions.

As part of this process, the Ministry of Health developed and integrated the digital tool “Alerta SIS” into the national electronic medical record system. This functionality supports clinical decision-making by reinforcing diagnostic suspicion when patients present compatible symptoms and travel history, helping sustain surveillance in a low-incidence context.

In the first measurement under RMEI’s performance-based framework, El Salvador qualified for a performance tranche — a discretionary financial incentive for use within the country’s health sector. The country maintains zero local transmission and demonstrates measurable progress in timely treatment, supply availability, and regulatory strengthening.

Through RMEI, the IDB continues to support El Salvador in consolidating resilient systems that not only eliminate malaria but prevent its return.