Abstract
BackgroundA malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework. Countries are considering the strategies and tools that will enable progress towards malaria goals. The eliminating malaria case-study series reports were reviewed to identify successful programme management components using a cross-case study analytic approach.MethodsNine out of ten case-study reports were included in the analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for malaria elimination programme management was developed and data were extracted and synthesized. Findings were reviewed at a consultative workshop, which led to a revision of the framework and further data extraction and synthesis. Success factors of implementation, programme choices and changes, and enabling factors were distilled.ResultsDecentralized programmes enhanced engagement in malaria elimination by sub-national units and communities. Integration of the malaria programme into other health services was also common. Decentralization and integration were often challenging due to the skill and experience levels of newly tasked staff. Accountability for programme impact was not clarified for most programmes. Motivation of work force was a key factor in maintaining programme quality but there were few clear, detailed strategies provided. Different incentive schemes targeted various stakeholders. Training and supervision, although not well described, were prioritized by most programmes. Multi-sectoral collaboration helped some programmes share information, build strategies and interventions and achieve a higher quality of implementation. In most cases programme action was spurred by malaria outbreaks or a new elimination goal with strong leadership. Some programmes showed high capacity for flexibility through introduction of new strategies and tools. Several case-studies described methods for monitoring implementation quality and coverage; however analysis and feedback to those implementing malaria elimination in the periphery was not well described. Political commitment and sustained financing contributed to malaria programme success. Consistency of malaria programmes depends on political commitment, human and financial resources, and leadership. Operational capacity of the programme and the overall health system structure and strength are also important aspects.ConclusionsMalaria eradication will require adaptive, well-managed malaria programmes that are able to tailor implementation of evidence-based strategies, founded upon strong sub-national surveillance and response, with adequate funding and human resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1518-9) contains supplementary material, which is available to authorized users.
Highlights
A malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework
Case-studies included in this cross case analysis are Bhutan [6], Cape Verde [7], Malaysia [8], Mauritius [9], Namibia [10], Philippines [11], Sri Lanka [12], Turkey [13], and Turkmenistan [14]
Implementation The ways in which malaria programmes were implemented were defined by several factors, including the level of decentralization and integration of the malaria programme, the health system in which the malaria programme operated its organizational structure and the accountability of the programme
Summary
A malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework. Countries are considering the strategies and tools that will enable progress towards malaria goals. A global goal of malaria eradication by 2040 was recently proposed [1], and at the same time, a new Global Technical Strategy for Malaria (GTS) was launched by WHO in 2015 and endorsed by all member states, providing the operational framework for achievement of elimination and stating an elimination goal of 35 countries by 2030 [2]. Ensuring that national malaria programmes have personnel with the appropriate level of programme management skills and tools to supervise and coordinate high quality implementation and evaluation is essential to achieving elimination, and, eradication [2]
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