Abstract
This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.
Highlights
Political scientists studying health policy have noted that while public health planning may commonly be framed as a rational technocratic exercise in problem-solving, the realities of policymaking rarely reflect this public health ideal (Bernier and Clavier, 2011)
The themes explored in this paper draw out ways that features of the political economy of malaria may play out at national levels, to provide explanations of policy choices outside of those arising from a purely technical review of data or evidence
They are mandated by Ministries of Health to take responsibility for malaria control, and typically staffed by technical staff—public health and infectious disease officials who strive to use data and evidence to select the most effective package of activities possible
Summary
Political scientists studying health policy have noted that while public health planning may commonly be framed as a rational technocratic exercise in problem-solving, the realities of policymaking rarely reflect this public health ideal (Bernier and Clavier, 2011). Authors have explained that there is a need to engage with a number of political and economic factors to understand why and how health policy decisions and outcomes come about outside the evaluation of technical evidence alone—factors including aspects of stakeholders and networks, power and influence, and governance or institutional contexts (de Leeuw et al, 2014; Gilson et al, 2018). The USA, provided 37.3% of global malaria funding, and the UK 9.2% in that year—with around half of international funding channelled through the Global Fund for HIV, Tuberculosis and Malaria (the Global Fund) (WHO, 2019) This raises important concerns about the influence and role of international donors and non-state stakeholders in shaping national policy and programme outcomes
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