Jaime Zamora, Consultant, Health Services Expert
Denisse Laos, Consultant, Digital Innovation Expert
RMEI – Regional Malaria Elimination Initiative
El Salvador was the first country in Central America to eliminate malaria as a prevalent disease within its national territory. In 2021, the World Health Organization certified its elimination, and since then, the country's authorities have reported no autochthonous cases. However, the absence of cases, while a success worth celebrating, also had a side effect: the health system stopped diagnosing malaria cases because there were none in the country, and health personnel could “forget” how to diagnose and treat malaria due to clinical memory loss and lack of experience in recognizing and managing the disease.
Nonetheless, El Salvador is a transit country, and its dollarized economy is very attractive to people from other countries seeking new job opportunities. Additionally, Salvadorans also cross the borders daily, entering from countries where malaria is still a reality. This situation increases the chances of the malaria parasite reappearing in the country.
All these factors —and considering that health personnel working in outpatient and hospital facilities has been gradually replaced by younger professionals more familiar with technology— the Ministry of Health opted to implement a digital solution to strengthen surveillance and ensure the rapid and efficient identification of suspected malaria cases.
Therefore, in 2024, the authorities of El Salvador—with the support of the Regional Malaria Elimination Initiative (IREM)—set out to implement a technological solution to ensure that malaria would not become a problem again. That solution was launched in April and will soon be deployed across the country.
How did they do it?
El Salvador has an Integrated Health System (SIS), which includes electronic medical records of its citizens, as well as laboratory, imaging, appointment management, and other modules. This system offers health professionals the necessary support and guidance to provide tailored responses to each patient. Leveraging this technological advantage, the government incorporated into this information system an alert integrated into SIS that enables professionals—after recording the symptoms reported by patients—to recognize a possible case of malaria and differentiate it from other diagnoses more easily. This alert recommends conducting a malaria diagnostic test which, if positive, activates the established protocol to treat the patient and prevent the disease from spreading. This algorithm within the SIS began implementation in April of this year. The innovative solution is called Alerta SIS.
Although it was initially conceived to support malaria detection, Alerta SIS is designed to expand to other diseases, starting with those transmitted by vectors such as dengue, Zika, and chikungunya. Its modular structure allows new clinical alerts to be added without altering the existing care flow, making it a versatile tool for febrile syndrome surveillance. Moreover, this functionality can be used to identify trends, trigger rapid responses, and reduce dependency on manual processes and paper-based reporting.
The goal is for the algorithm to be implemented in all health facilities nationwide by the end of this year, so that frontline health professionals no longer depend solely on their knowledge and memory but receive system support in identifying suspected malaria cases. It also strengthens epidemiological surveillance without interrupting regular clinical practice. In this way, El Salvador's health system is not only more effective in caring for people and remaining malaria-free, but it also helps prevent travelers entering its national territory from returning to their countries with the malaria parasite and affecting their communities.
RMEI's Support
Implementing this technological innovation required the participation of many branches of the Ministry of Health, which led its development with the technical and digital support of the Regional Malaria Elimination Initiative and the experience of specialists from El Salvador’s Ministry of Health and the Inter-American Development Bank (which manages IREM). IREM facilitated the design of Alerta SIS, ensuring it met care and epidemiological surveillance needs and integrated into existing care flows. This support accelerated the fight against the parasite and was achieved through an extraordinary nationwide coordination effort that included everything from training health personnel to adjusting basic epidemiological elements such as malaria case definitions.
Today, El Salvador is a model to follow in this regional fight against malaria, not only for being certified as malaria-free by the WHO, but for its commitment to staying that way. With IREM's support, it has implemented pioneering technological solutions that help ensure this Central American country continues to remain free of the parasite.