Health systems and global progress towards malaria elimination, 2000\u20132016

Maitreyi Sahu,John J Aponte,Abdisalan M Noor,Günther Fink,Fabrizio Tediosi

doi:10.1186/s12936-020-03208-6

Abstract

BackgroundAs more countries progress towards malaria elimination, a better understanding of the most critical health system features for enabling and supporting malaria control and elimination is needed.MethodsAll available health systems data relevant for malaria control were collated from 23 online data repositories. Principal component analysis was used to create domain specific health system performance measures. Multiple regression model selection approaches were used to identify key health systems predictors of progress in malaria control in the 2000–2016 period among 105 countries. Additional analysis was performed within malaria burden groups.ResultsThere was large heterogeneity in progress in malaria control in the 2000–2016 period. In univariate analysis, several health systems factors displayed a strong positive correlation with reductions in malaria burden between 2000 and 2016. In multivariable models, delivery of routine services and hospital capacity were strongly predictive of reductions in malaria cases, especially in high burden countries. In low-burden countries approaching elimination, primary health center density appeared negatively associated with progress while hospital capacity was positively correlated with eliminating malaria.ConclusionsThe findings presented in this manuscript suggest that strengthening health systems can be an effective strategy for reducing malaria cases, especially in countries with high malaria burden. Potential returns appear particularly high in the area of service delivery.

Highlights

As more countries progress towards malaria elimination, a better understanding of the most critical health system features for enabling and supporting malaria control and elimination is needed
This report recognizes that a successful programme will need to strengthen health systems capacity by increasing human resources and developing management competency at the provincial level, but highlights that historically malaria elimination has been achieved in many countries well before health systems have provided universal coverage [9]
The conceptual approach for this study focused on identifying characteristics of health systems most predictive of progress in malaria control conditional on contextual factors, and is presented in Additional file 1: Analytical Framework

Summary

Introduction

As more countries progress towards malaria elimination, a better understanding of the most critical health system features for enabling and supporting malaria control and elimination is needed. In 2010, several studies were published on the technical and operational feasibility of malaria elimination Most of these studies focused on strategies and needs for interrupting transmission, and on assessing countries’ ability to create effective national malaria programmes at scale [17,18,19,20,21]. This report recognizes that a successful programme will need to strengthen health systems capacity by increasing human resources and developing management competency at the provincial level, but highlights that historically malaria elimination has been achieved in many countries well before health systems have provided universal coverage [9]

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Conclusion