The world had spent 15 years pushing malaria into retreat. That progress has now stalled, and in several places reversed, driven by a collapse in donor financing, growing drug and insecticide resistance, and the compounding effects of conflict and climate shocks. Kenya has weathered this downturn better than most of the continent, but it is not escaping it. 

The World Health Organization’s (WHO) newest global assessment paints a difficult picture worldwide. For Kenya specifically, however, the story carries more nuance: two decades of targeted investment, including some of the earliest vaccine rollouts on the continent, have kept the country’s burden at a fraction of the African average, even as rising case numbers and shrinking donor budgets now test whether that progress can hold. 

Globally, the WHO recorded an estimated 282 million malaria cases and 610,000 deaths in 2024, the highest case count in over two decades. Malaria funding that year reached just Ksh3.9 billion ($3.9 billion) against the Ksh9.3 billion ($9.3 billion) the Global Technical Strategy identifies as the minimum needed for that year alone. Africa carries the brunt of this: the WHO African Region accounts for an estimated 94 per cent of global cases and 95 per cent of deaths, with children under five bearing the sharpest toll. 

Kenya, within that picture, carries about 1.5 per cent of the world’s malaria cases, an estimated 4.2 million in 2024, a 27 per cent jump from 2023 and the highest single-year increase in recent data. Yet Kenya’s case incidence per 1,000 people at risk stands at about 82, compared to an African regional average of 236, roughly a third of the continental burden, a gap that reflects two decades of targeted investment rather than luck. 

Egypt, Cabo Verde Georgia, Suriname and Timor-Leste are certified malaria-free countries 

Between 2000 and 2015, global malaria case incidence had fallen by 25.6 per cent, from 79.4 to 59.0 cases per 1,000 people at risk, driven by insecticide-treated nets, artemisinin-based combination therapies, indoor spraying and rapid diagnostic testing. Since 2015, cases are reported to be up 22.6 per cent, a trajectory the WHO report describes simply as progress reversed. The 2020 Covid-19 pandemic alone pushed an additional estimated 11 million cases and 55,000 deaths into the global tally as routine health services faltered. 

Since 2000, an estimated 2.3 billion cases and 14 million deaths have been averted worldwide, with Africa accounting for 76 per cent of averted cases and 93 per cent of averted deaths. Egypt and Cabo Verde were certified malaria-free in 2024, and Georgia, Suriname and Timor-Leste followed in 2025, bringing the global total to 47 malaria-free countries. Cabo Verde has since seen a resurgence, a reminder of how quickly such gains can erode without sustained vigilance. 

South-East Asia and Africa now sit at opposite ends of the same fight. Since 2000, South-East Asia has cut its malaria case count by 89 per cent, from 23.6 million to about 2.7 million, meeting its 2020 WHO milestone through sustained investment and relentless surveillance. Africa moved in the opposite direction over the same period, from roughly 203 million cases in 2000 to 265 million by 2024, a 31 per cent rise. 

 Just five countries, Nigeria, the Democratic Republic of the Congo (DRC), Uganda, Ethiopia and Mozambique, now account for about half of all global cases. Ethiopia added an estimated 2.9 million cases in 2024 linked to conflict-related service disruption, Madagascar added 1.9 million after extreme climate events, and Rwanda saw a 43.8 per cent rise tied to climate shifts and emerging resistance. 

The report devotes an entire chapter to what it calls one of its most alarming findings: partial resistance to artemisinin, the backbone of first-line treatment across sub-Saharan Africa, has now been confirmed or suspected in at least eight African countries, alongside signs of declining efficacy in the partner drugs used alongside it. The WHO identifies four converging vulnerabilities in the region: artemisinin resistance, parasites evading rapid diagnostic tests, insecticide-resistant mosquitoes, and the spread of Anopheles stephensi, an urban-adapted mosquito species new to African cities, into environments well suited to it. 

In 2024, Kenya received 16.6 million insecticide-treated nets, the joint-largest allocation of any country globally 

Kenya was among the first three countries, alongside Ghana and Malawi, to pilot the RTS,S malaria vaccine ahead of its WHO approval in 2021, and is now among the first nations to run both approved malaria vaccines, RTS,S and R21/Matrix-M, through routine immunisation. An evaluation of RTS,S across Ghana, Kenya and Malawi, covering roughly two million vaccinated children between 2019 and 2023, found a 13 per cent reduction in mortality and a 22 per cent reduction in severe malaria hospitalisations among eligible children. 

In 2024, Kenya received 16.6 million insecticide-treated nets, the joint-largest allocation of any country globally that year, distributed through a campaign targeting 22 counties and 27 million at-risk Kenyans, with the first phase covering Homa Bay, Kisii, Nyamira, Kisumu, Siaya, Migori, Kwale, Mombasa and Taita Taveta under full digital tracking. Kenya’s updated 2024 National Malaria Policy has also enabled 103,000 Community Health Promoters to report malaria and neglected tropical disease data in real time through the DHIS2 platform, and folds malaria case management into SHA’s primary healthcare structure. 

Yet gaps remain. Preventive treatment coverage for pregnant women has fallen sharply: from 49 per cent in the Lake endemic zone and 46 per cent on the coast in 2020, to just 38 per cent and 29.2 per cent respectively by 2022. Kenya’s first seasonal chemoprevention pilot, launched in Turkana County in 2024 and targeting children under five, aims for an 80 per cent reduction in severe cases before being scaled to other seasonal transmission zones. In Nyanza and Western Kenya, Amref Health Africa’s Global Fund-backed community case management programme expanded from 850 to 2,210 community health units between July 2024 and March 2025, raising coverage from 32 to 81 per cent. 

The clearest current setback is in Busia and Migori, within Kenya’s highest-transmission lake zone, where Indoor Residual Spraying could not proceed after US funding was withdrawn, according to Amref’s programme director for disease control, George Githuka, a gap both counties had relied on to complement net distribution during peak transmission. 

The underfunding predates the latest shocks, but 2025 made it acute. The US terminated most of its global health programmes under a restructuring of its emergency plan, cancelling 80 per cent of USAID awards that included malaria activities, after contributing an average of 37 per cent of global malaria financing between 2010 and 2023.  

WHO set to cut malaria cases and mortality by 90 per cent before 2030. With six years left, cases and deaths have risen 

By early April 2025, nearly 30 per cent of planned insecticide-treated net campaigns were off-track or at risk, over 40 per cent of all ITN campaigns and nearly 30 per cent of seasonal chemoprevention campaigns were delayed, and stocks of rapid tests and combination therapies ran critically low across Africa. WHO Assistant Director-General Dr Jérôme Salomon warned the setbacks threatened to reverse decades of progress; internal WHO analysis estimated that a permanent halt to the US President’s Malaria Initiative could cause 12.5 to 17.9 million additional cases and 71,000 to 166,000 additional deaths annually. Some US funding has since been partially reinstated, but the structural gaps will not close quickly. 

Some countries are moving to fill the shortfall themselves. Nigeria’s legislature approved an additional Ksh25.9 billion ($200 million) for its health sector in 2025. End Malaria Councils across Mozambique, Tanzania, Uganda and Zambia raised Ksh8 billion ($62 million) in domestic and private support in 2024. Kenya’s own Zero Malaria Campaign Coalition, led by the National Malaria Control Programme with Amref Health Africa, the Council of Governors, the Global Fund and Malaria No More, convened a steering committee in mid-2025 specifically to assess the damage and plan a response. 

The WHO’s Global Technical Strategy set a target of cutting malaria case incidence and mortality by 90 per cent between 2015 and 2030. With six years left, the world is not on track: cases have risen, deaths remain above the 2015 baseline of 578,000, and the financing base that carried the first 15 years of progress is under real strain. A cross-partner WHO and RBM Partnership working group formed in March 2025 to coordinate support for the most exposed countries, and the Africa Centres for Disease Control and Prevention issued its own health financing strategy the following month, as national governments are increasingly asked to absorb costs donors once carried. 

For Kenya, the path forward means sustaining what has worked, net coverage, vaccine integration, community health systems and digital surveillance, while closing the gaps left by withdrawn bilateral support. The Kenya Malaria Strategy 2024–2027 provides the framework. Whether the resources materialise to carry it out is a question that now extends well beyond any single ministry. 

Sources: WHO World Malaria Report 2025; Kenya MoH National Malaria Policy (2024); Kenya Malaria Strategy 2024 to 2027; PMI Kenya Malaria Profile FY2024; Kenya Malaria Indicator Survey 2020; KDHS 2022; ALMA Africa Malaria Progress Report 2024; WHO Malaria Financing Policy Brief (2025); KFF Foreign Aid Review (2025). 

Data visualisation: Stanley Njihia 

Text: Yvonne Kawira