Abstract
BackgroundCommunity-based service delivery is vital to the effectiveness, affordability and sustainability of vector control generally, and to labour-intensive larval source management (LSM) programmes in particular.Case descriptionThe institutional evolution of a city-level, community-based LSM programme over 14 years in urban Dar es Salaam, Tanzania, illustrates how operational research projects can contribute to public health governance and to the establishment of sustainable service delivery programmes. Implementation, management and governance of this LSM programme is framed within a nested set of spatially-defined relationships between mosquitoes, residents, government and research institutions that build upward from neighbourhood to city and national scales.Discussion and evaluationThe clear hierarchical structure associated with vertical, centralized management of decentralized, community-based service delivery, as well as increasingly clear differentiation of partner roles and responsibilities across several spatial scales, contributed to the evolution and subsequent growth of the programme.ConclusionsThe UMCP was based on the principle of an integrated operational research project that evolved over time as the City Council gradually took more responsibility for management. The central role of Dar es Salaam’s City Council in coordinating LSM implementation enabled that flexibility; the institutionalization of management and planning in local administrative structures enhanced community-mobilization and funding possibilities at national and international levels. Ultimately, the high degree of program ownership by the City Council and three municipalities, coupled with catalytic donor funding and technical support from expert overseas partners have enabled establishment of a sustainable, internally-funded programme implemented by the National Ministry of Health and Social Welfare and supported by national research and training institutes.
Highlights
Community-based service delivery is vital to the effectiveness, affordability and sustainability of vector control generally, and to labour-intensive larval source management (LSM) programmes in particular.Case description: The institutional evolution of a city-level, community-based LSM programme over 14 years in urban Dar es Salaam, Tanzania, illustrates how operational research projects can contribute to public health governance and to the establishment of sustainable service delivery programmes
The Urban Malaria Control Programme (UMCP) was based on the principle of an integrated operational research project that evolved over time as the City Council gradually took more responsibility for management
Indoor residual spraying (IRS) of houses with insecticides [1,2] and insecticide-treated nets (ITNs) [3] are the front line malaria vector control measures recommended across the globe and in Africa [4]
Summary
Despite these collaborative challenges – not to mention the operational setbacks attendant to translating theory and good will into de facto public health practice – malaria prevalence and mosquito densities have consistently declined across the UMCP pilot area as larviciding has been sequentially scaled up [24,26]. Wide-scale community-based implementation can be effectively achieved through a decentralized vertical management structure, utilizing the hierarchical gradient of implementation strategies and partner roles across all the necessary spatial scales Such centralized coordination is essential to enable institutionalization of strengthened management and planning, improved community mobilization capability, and capacity to exploit national and international funding systems. Training and developments costs should be included in budgets that are strategically planned and consistently supported over the long term so that locally-adapted LSM programmes and their supporting institutions have sufficient time to learn, consolidate and stabilize Such pilot programmes should follow clear, prospectively designed institutionalization plans that unambiguously delineate who will do what, at what spatial scale, and how the multiple independent institutions that are required will interact. The key achievement is that is no longer a set of operational research projects but rather a nationally owned public health programme in the strict sense, so it will have the opportunity to evolve, adapt and improve over the long term
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