The Geneva Learning Foundation (TGLF) is pleased to announce ‘Malaria: Turning the Tide’, the first peer learning course by and for health workers. Learn more about the course… Enroll now in English or French. This article is based on experiences shared by health workers during the live event ‘Malaria: Turning the Tide’ on 23 April 2026 to launch the report, two days ahead of World Malaria Day.
On 23 April 2026, World Malaria Day, the Foundation broadcast a bilingual public conversation around it, with more than 2,500 registrations on LinkedIn alone.
Bisimwa Muzusa Emmanuel is a physician in Bukavu, in the eastern Democratic Republic of the Congo.
This year, all three of his children, aged one, three and five, came down with malaria at the same time.
The youngest was hospitalised.
Every one of them had been sleeping under a treated bed net.
“This has been a period of psychological and financial upheaval,” he wrote in his contribution to a new report on malaria, the kind of line a physician offers when the disease he treats every day arrives at his own front door.
The report is called Malaria: Turning the Tide.
It is the nineteenth Listening and Learning report from the Geneva Learning Foundation, an independent Swiss foundation that runs structured peer learning networks for frontline health and humanitarian workers.
The report draws on more than 1,000 contributions from malaria-endemic countries.
On 17 May 2026, the next phase begins: a peer-reviewed online course, Malaria: Turning the tide, will kick off for any health worker, programme manager, researcher or funder who wants to make sense of the report and use it to strengthen their action.
What the report and the broadcast captured may not yet appear in the global evidence base.
Sometimes, the patterns confirm what is already known.
In such cases, its contribution is the operational texture, the local conditions under which a known intervention succeeds or fails.
A plateau, viewed from the inside
The headline numbers are bleak.
The World Health Organization estimated 610,000 malaria deaths globally in 2024, with a mortality rate of 13.8 per 100,000 people at risk and 95% of those deaths in the WHO African Region.
The Global Technical Strategy target for that mortality rate, set in 2015 for the year 2025, was 4.6.
The world is running roughly three times above the target it set itself.
The frontline workforce who participated in the report did not describe a plateau.
They described an ongoing event in their own homes.
Dr Kouamé Georges Konan, a recently retired departmental director of health in Abidjan, called in to the French launch event.
“As I speak to you today, I am retired, that is true,” he said. “But everyone around me has malaria and they are under treatment while I am here. Madame, my youngest daughter, right now, she is under treatment, malaria. Which is to say it is a current concern.”
The phrase Kouamé reached for, une maladie d’actualité, does not survive translation cleanly.
It carries a sense of a problem that refuses to age.
The participants wrote and spoke as people for whom malaria is the practical content of their work week.
What counts as evidence
A trained epidemiologist, reading the lines from Bisimwa and Kouamé, will classify such stories as anecdotes, the lowest rung of the conventional pyramid of evidence.
That pyramid is the right tool for some questions and the wrong tool for others.
Reda Sadki opened the broadcast with the methodological frame that runs through the report.
“Experience is strong on context, but be careful because it is weak on generalisation,” he said. “One story does not prove what is going to work somewhere else. It shows what is possible and what to test. Where experience and routine data and trial evidence disagree, do not choose. Ask why they differ. That question is where the next answer lives.”
The slides shown during the broadcast were explicit on the limits of any single account.
They are local and specific, and should be paired with routine surveillance and trial evidence before they travel.
The frame draws on the literature on practitioner knowledge that distinguishes the high ground of formal research from the swampy lowlands of daily practice.
The ‘high ground’ produces technically clean answers to the less consequential questions.
The ‘swampy lowlands’ are where the answers are harder to formalise and the problems of greatest human concern actually live.
Malaria control in 2026 is a swampy-lowland problem.
The biology is well understood.
The drugs work.
The vaccines work.
The bed nets, deployed correctly, work.
What remains hard, in the places where most deaths occur, is the daily encounter between a febrile child, a sick adult, and the system meant to test, treat and track them.
A single account of that encounter is an anecdote.
A thousand accounts, gathered systematically across 68 countries, peer-reviewed by colleagues in similar conditions and patterned across geographies and roles, are something else.
They are knowing-in-action, the practical wisdom produced when people who do the work talk to each other about what they have learned.
Where formal evidence reports the average effect of an intervention across a population, patterned practitioner accounts may reveal how change actually happens in a given setting, who does what, what the local trust hierarchies look like, and which procedural details determine whether the same nominal intervention succeeds or fails.
The mosquito has changed its hours
Joseph Gyebi-Buaben, a public health worker at the Ghanaian Ministry of Health in Dormaa East, made the point in his contribution to the report.
“We have always learnt that Anopheles bite at night and rest during the day but this has changed,” he wrote. “I think our usual approach and thinking about mosquitoes needs to shift to this new dynamic.”
The bed net assumes the moments of risk fall inside the hours a person spends in bed.
Joseph’s observation suggests the assumption deserves a refresh, in his district, this season.
A second illustration came from southern Africa.
Catherine Murombedzi, a Zimbabwean health journalist, wrote into the broadcast chat with figures from her national programme.
Through epidemiological week 23 of 2025, Zimbabwe had recorded 111,998 malaria cases and 310 deaths, against 29,031 cases and 49 deaths over the same period of 2024.
Mashonaland Central accounted for 32% of cases.
Manicaland accounted for 25% of deaths.
“In Zimbabwe the village health workers are the eyes, ears and voice in disease outbreaks and controls,” she wrote. “These are not statistics, these are people affected.”
Africa CDC attributed the surge to extended rainfall associated with the tail of Cyclone Chido, which struck Mozambique in mid-December 2024.
The patterns are consistent with what climate epidemiologists have been modelling.
The participants offered something the models do not: where new outbreaks are showing up first, who sees them first, and what local programmes are doing in response.
What the formal evidence is still catching up with
Climate explains a piece of the plateau.
The rest lives in the encounters the formal health system may not record.
The participants returned to this point all afternoon, in two languages.
Selina Akunna Enyioha, a retired director of nursing in Nigeria who runs a community health initiative, opened the English session with a description that anyone working in West African primary care will recognise.
“They prefer going to a nearby place, maybe in a chemist shop instead of going to the hospital,” she said. “Right now, transportation is so expensive. And often a time, they are given bono treatment.”
Bono is Nigerian-English shorthand for the over-the-counter cocktail of paracetamol, chloroquine and whatever else the chemist has on the shelf, sold as the standard fever package, without a test.
Maryam Jimoh, also from Nigeria, made the same point in the chat with the directness of someone who had just lived it.
“I just treated my both kids of malaria. We did an RDT,” she wrote. “Honestly, store bought malaria medicine are usually the norms in this part of the world.”
Published evidence has been pointing in this direction for at least a decade.
Across sub-Saharan Africa, fewer than half of febrile children under five receive a diagnostic test, the share who receive a quality-assured artemisinin-based combination therapy is lower still, and the test-and-treat protocol drops further in private retail outlets.
The most recent African Union malaria progress report restates the gap.
What the participants add is texture.
The specific phrase a community uses for fever self-treatment.
The price elasticity that makes the chemist shop the rational first choice.
The fact that, in some cases, the clinician who buys store-bought antimalarials for her own children is the same clinician who would prefer to test them.
Phenina Andrew drew the operational conclusion: “Many malaria cases are treated incorrectly outside the public system. It highlights the need to engage and train private providers on proper testing and treatment because they are often the first point of care.”
The data dysfunction got its own framing, from the floor.
Alaouiatu Usman Ibrahim, a retired nurse-midwife from Bauchi State who spent decades on Nigerian primary care, framed the work in a single line.
“What we normally do when we identify such discrepancy during data quality assessment, even though the goal is not to embarrass anybody, but we want to correct, to ensure that the data is qualitative.”
The dashboards say the indicators are green.
The registers in the local government area office tell a different story.
The patent medicine vendors do not appear in either.
The point of data quality work, Alaouiatu was saying, is not to find a guilty party.
It is to make the figures match the disease.
Jimoh Dare, a monitoring and evaluation officer based in Abuja, contributed an eleven-point framework in the chat for reconciling local registers with the national health management information system.
Acheampong Kudom, a Ghanaian community health worker, posted a three-step protocol for getting patients to disclose what private treatments they had already taken.
“One: acknowledge their belief to gain their trust. Two: ask about what they believe the cause of their condition is, and what treatment they believe will work best. Three: they will be open to tell you more.”
A piece of field-tested clinical practice written by a clinician for other clinicians, in the chat of a public broadcast, in the middle of a working day.
The vaccine arrives
There is now an additional tool that complements the existing arsenal.
It does not replace bed nets, indoor residual spraying, seasonal chemoprevention or test-and-treat.
It adds to them.
The World Health Organization recommended the RTS,S/AS01 vaccine for widespread use in October 2021.
It prequalified the second-generation R21/Matrix-M vaccine in December 2023.
On 15 July 2024, Côte d’Ivoire became the first country in the world to deploy R21 in a routine immunisation programme.
Liliane Mutua, who heads health promotion for Nairobi City County in Kenya, came on the live broadcast with the early operational picture.
The Kenyan rollout, she said, had reached twenty-five counties.
In Homabay County, on the Lake Victoria shore, malaria infection rates had fallen from 27% to 3.6% over five years following the introduction of the vaccine, with severe paediatric malaria hospitalisations dropping in step.
“Science and evidence works,” Mutua said. “Vaccines can work.”
The participants did not treat the vaccine as a finished story.
Kingsley Kofi Nignere, a community health worker in Kintampo, Ghana, said his work was being slowed by misinformation videos about RTS,S in his communities.
Mary Caleb, working in Nigeria’s Federal Capital Territory, said religious leader engagement had become her most reliable pathway to acceptance for any new intervention, including the seasonal malaria chemoprevention rollout that had at first met resistance.
Hamida Mohammed Yeldu, an immunisation officer at a Nigerian medical clinic, wrote it more plainly. “Community leaders and health care providers based in that community are those that their voice are highly heard in accepting any remedy in tackling malaria issues.”
The published vaccine literature reports efficacy.
The participants reported the layer of work that determines whether the efficacy translates into coverage.
Which trusted local figure carries the message.
What the misinformation video looks like.
Which week of the rollout the rumour appears.
The workforce is the bridge
What has been documented in the published evidence for years, and what the broadcast made impossible to ignore, is that the malaria response stalls at the workforce.
Reda Sadki and Charlotte Mbuh, in a recent analysis drawing on a synthesis by Halima Mwenesi and colleagues, argued that the missing piece in the malaria plateau is the systematic neglect of the human resources who deliver the response: their training, their tools, their data systems, their place in the planning cycle.
Dr Abdurrahman Babatunde Bello, a parasitologist at the University of Ibadan, presented findings from his own research showing that 44% of households in his study area had refused indoor residual spraying.
The reason was not anti-vector sentiment.
The implementation team had arrived without warning, without explanation and without trust.
The technical intervention had been correct.
The pre-implementation engagement had failed.
Everyone should be listening to this conversation.
With the funding picture for global health more constrained than ever, we cannot afford to fail at implementation.
The U.S. government has wound down its support for some of the primary health care provider engagement in West and Central Africa, where between one and five percent of the regional malaria budget had been keeping local provider supervision running.
The disease has not paused for the funding picture.
The argument the report makes is that the most productive investment now available is in the ability of the global, national and frontline parts of the response to work as a single system, with evidence travelling in both directions.
Making a bet that we can turn the tide, together
The Geneva Learning Foundation (TGLF) has staked a position on what comes next.
It is a new entrant to the malaria response and is explicit about that.
The proposition is to complement existing initiatives, not substitute for them.
The Foundation argues it is uniquely positioned to contribute to unravelling the workforce challenges that have stalled progress, alongside the agencies and partners who are already supporting national programmes.
The next step is the course that opens on 17 May 2026, where any practitioner, manager, researcher or funder can join the next round of structured peer learning.
From there it moves into a data quality cycle and a local action cycle, both organised around the kinds of patterns the participants have just demonstrated they can produce.
TGLF’s Charlotte Mbuh was clear about the distinction between the gathering and its purpose.
The goal is to change outcomes.
The leaders are frontline practitioners who work with and as part of the community.
The mechanism is the systematic capture, validation and circulation of practitioner knowledge alongside the best available global knowledge, on the assumption that each is incomplete without the other.
Dr Daphnée Michel, a public health physician in Haiti, has been part of that mechanism since late 2017.
She joined TGLF, she explained on the broadcast, during the neonatal tetanus elimination surveys, and stayed through nearly a decade of structured peer learning.
“With the Foundation, I have learned, I have shared, I have done networking with colleagues from other countries,” she said. “It has not only added to my professional knowledge but also improved my skills at work.”
Her trajectory, from data quality work at NGO entry level to senior public health responsibility, is the longitudinal version of what was happening in real time across the broadcast.
A current concern
As the English-language session was winding down, an immunisation officer named Boubakari Hamadou, working in Maroua, in the far north of Cameroon, brought home a key message: “My participation allowed me to understand the realities elsewhere,” he wrote, “and to know that the challenges I encounter are also possible elsewhere.”
The line reads, to the policy professional, as the modest appraisal of a frontline worker grateful for a course.
Read again, with the rest of the broadcast in mind, it is something more pointed.
The encounter between Hamadou’s clinic in Maroua and the contributions from sixty-seven other countries has produced a piece of information no single observer could have generated alone.
The system that confronts him in Maroua is the system that confronts Bisimwa in Bukavu, Kouamé’s daughter in Abidjan, Catherine’s neighbours in Mashonaland Central, Maryam’s two children at home with their store-bought tablets, and Daphnée’s patients in Haiti.
Sarah Kamangu Meta, a community health worker in Mont-Amba in Kinshasa, put a sharper version of the same point into the report. “Before, I did not master the subject in detail, and I did not see malaria as a disease to avoid since most people are already used to it. Following this training I changed my way of seeing it.”
Malaria: Turning the Tide is open access.
The course opens on 17 May 2026.
The argument the participants are making, in their own words and at their own desks, is that the people closest to the disease have a body of knowledge the global response can use.
Where their patterns confirm what trial evidence and routine data already show, the value is in the operational texture.
Where they disagree, the disagreement is the next research question.
References
- Africa CDC. (23 July 2025). Malaria surge in Southern Africa.
- African Leaders Malaria Alliance. (2024). 2024 Africa Malaria Progress Report.
- Beaubien, J., et al. (2015). Quality of antimalarial drugs and treatment in sub-Saharan Africa. PubMed Central.
- The Geneva Learning Foundation. (2026). Malaria: from the shadows to the light (course).
- The Geneva Learning Foundation. (2026). Malaria: Turning the Tide (English report).
- The Geneva Learning Foundation. (2026). Le paludisme: changer le cours des choses (French report).
- PATH. (27 June 2025). A shot of hope: how the malaria vaccine is helping to change lives in Kenya.
- Sadki, R. (14 December 2024). Knowing-in-action: bridging the theory-practice divide in global health.
- Sadki, R. (8 February 2026). Rethinking human resources for malaria control and elimination in Africa.
- Sadki, R. (17 April 2026). Turning the tide: a new insights report demonstrates why health worker knowledge is critical to ending malaria.
- UN OCHA. (16 December 2024). Southern Africa: tropical cyclone Chido flash update no. 4.
- University of Oxford. (15 July 2024). Côte d’Ivoire makes history as first nation to deploy R21/Matrix-M malaria vaccine.
- World Health Organization. (6 October 2021). WHO recommends groundbreaking malaria vaccine for children at risk.
- World Health Organization. (21 December 2023). WHO prequalifies a second malaria vaccine, a significant milestone in prevention of the disease.
- World Health Organization. (February 2026). Q&A on RTS,S malaria vaccine.