Malaria Elimination in Suriname, Timor-Leste and Georgia: Strategic Lessons for Sub-Saharan Africa.

BACKGROUND: Malaria remains a major cause of morbidity and mortality worldwide, with over 263 million cases and 597,000 deaths estimated in 2023, of which 94% occurred in Sub-Saharan Africa. Despite this heavy burden, several low- and middle-income countries have recently succeeded in eliminating local malaria transmission. OBJECTIVE: This article describes and synthesises malaria elimination experiences in Suriname, Timor-Leste and Georgia, all three certified malaria-free by the World Health Organization in 2025, to identify strategic lessons and contextual factors that may inform elimination efforts in malaria-endemic countries, including those in Sub-Saharan Africa. METHODOLOGY: A structured narrative review was conducted using official reports from WHO, the Global Fund and PAHO; national public health documents; and peer-reviewed articles indexed in PubMed, Scopus and Google Scholar between 2012 and 2025. Search terms included 'malaria elimination,' 'malaria-free certification,' 'Suriname malaria,' 'Timor-Leste malaria' and 'Georgia malaria.' Inclusion criteria required relevance to elimination strategies, publication in English or French and availability in full text. Grey literature from WHO, PAHO and the Global Fund was systematically included. RESULTS: The three countries share several common determinants of success: strong and sustained political commitment, robust epidemiological surveillance systems, active community mobilisation and consistent financial support. Strategies were adapted to context: involvement of indigenous communities and cross-border control in the Amazon basin (Suriname), universal coverage and extensive partner support in a postconflict setting (Timor-Leste) and institutional resilience and postelimination vigilance in a context of political transition (Georgia). CONCLUSION: These experiences demonstrate that malaria elimination is achievable even in resource-limited or fragile contexts, provided interventions are tailored to the local setting and supported by coherent governance. Key lessons for malaria-endemic countries include strengthening community-based surveillance, cross-border cooperation, community education and securing sustainable financing. The risk of reintroduction remains real, and postelimination vigilance is essential.