Abstract
ABSTRACT Background: The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria. South Africa has been declared ready to institute malaria elimination. However, research on the factors that would affect this policy implementation is inadequate. Objective: To investigate the stakeholders’ understanding of the malaria elimination policy in South Africa, including their perceived barriers and facilitators to effective policy implementation. Methods: The study followed a constructivist epistemological approach which manifests in phenomenological study design. Twelve purposively selected key informants from malaria researchers, provincial and national malaria programmes were interviewed using semi-structured interviews. Interview questions elicited interviewees’ knowledge of the policy and its achievability, including any perceived barriers and facilitating factors to effective implementation. The hybrid approach was used to perform thematic data analysis. Results: The dominant view was that malaria remains a problem in South Africa, exacerbated by staff attitudes and poor capacity, lack of resources, lack of new effective intervention tools, lack of intra- and inter-departmental collaboration, poor cross-border collaboration and weak stakeholder collaboration. Informants were concerned about the target year (2018) for elimination, and about the process followed in developing the policy, including the perceived malaria epidemiology shortfalls, regulatory issues and political context of the policy. Conclusions: Achievability of malaria elimination remains a subject of intense debate for a variety of reasons. These include the sporadic nature of malaria resurgence, raising questions about the contributions of malaria control interventions and climate to the transmission trends in South Africa. The shortage of resources, inadequate staff capacity, lack of any new effective intervention tools, and gaps in malaria epidemiology were key concerns, as was the superficially participative nature of the consultation process followed in developing the policy.
Highlights
The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria
The gains made reflect the decisive steps taken by the international malaria community over the years, including the launch of the Roll Back Malaria (RBM) Movement in 1998, the Abuja Declaration in 2000, the launch of the Eight United Nations (UN) Millennium Development Goals (MDGs) in 2000 and the launch of the Global Malaria Action Plan (GMAP) in 2008 [3,4]
Ethics of implementing malaria elimination strategy A point was made that the elimination policy lacked scientific backing and its implementation may be ethically questionable (Key Informant 10): If we look at the current South African Malaria Elimination Strategy, I believe there is some activities in there which are not properly informed by scientific evidence and I almost feel it might be almost unethical to implement some of those and the ethics will come into effect that I need to get resources out of the health budget and I might take resources away from another priority programmes if I can fight hard enough for it
Summary
The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria. Objective: To investigate the stakeholders’ understanding of the malaria elimination policy in South Africa, including their perceived barriers and facilitators to effective policy implementation. Achievements in the fight against malaria over the past decade are well documented [1] Despite these gains, malaria continues to be a leading cause of morbidity and mortality in the world, with approximately 214 million annual cases and 438,000 deaths in 2015 [2]. In endemic areas of Africa, the incidence of clinical cases decreased by 40% between 2000 and 2015 [4]. About 109 countries are free from malaria, but 67 are still malaria endemic with 34 poised to eliminate malaria over the 2013 to 2035 period [5,6,7,8]
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