Abstract
Policy change in a dynamic environment amidst an increasing infectious disease caseload remains a herculean task. While it is ideal to drive the process using evidence, emergencies in such situation makes policy transfer the best option. However, considering the difference in contextual health system issues which could affect the policy performance, how does a ‘wholesale’ transferred policy perform in a changing environment? Who do international actors drive the process of policy transfer? What is the motivation of national actors to adopt a policy without context-specific evidence? Using the Dolowitz and Marsh model of policy transfer, this paper reviews the processes of policy change of malaria regimen from monotherapies such as chloroquine to artemisinin combination therapies. It assesses the fundamental influencers of this transfer and the strategies employed in making this change. Also, the challenges encountered during this process are discussed within the spectrum of the model. Lessons from this transfer process are relevant in guiding future policy changes of infectious diseases in other resourceconstrained settings in Africa.
Highlights
The global health fight against malaria was threatened in 1972 when the first case of plasmodium falciparum resistance to chloroquine (CQ) and sulphadoxine pyrimethamine (SP) was reported [1]
Health authorities in Zambia were taken by surprise by the unprecedented number of malaria cases which prompted them to seek advice from WHO leading to an adoption of Arthemeter Lumenfantre (AL) in less than 3 months [4]
Under the terms of engagement, WHO was responsible for distributing it to public sector authorities who agreed to join the program by using AL as first line treatment medicine whiles African leaders under the GFATM program were responsible for making purchases directly through Global Fund under these special arrangements [25]
Summary
The global health fight against malaria was threatened in 1972 when the first case of plasmodium falciparum (pf) resistance to chloroquine (CQ) and sulphadoxine pyrimethamine (SP) was reported [1]. This swift but systematic process was necessary to impede the horrifying number of deaths across these countries and delay the extent of antimalarial resistance. Health authorities in Zambia were taken by surprise by the unprecedented number of malaria cases which prompted them to seek advice from WHO leading to an adoption of Arthemeter Lumenfantre (AL) in less than 3 months [4] In this emergency, just like in most instances where insiders lead an idea for a policy transfer, local evidence plays a minor role in development processes [17]. These initiatives have financially supported countries with the purchase of ACTs and further delivered technical support for policy implementation
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