Challenges in and lessons learned during the implementation of the 1-3-7 malaria surveillance and response strategy in China: a qualitative study

Abstract

BackgroundChina has made great progress in malaria control over the last century and now aims to eliminate malaria by 2020. In 2012, the country launched its 1-3-7 surveillance and response strategy for malaria elimination. The strategy involves to case reporting within 1 day, case investigation within 3 days, and focus investigation and public health actions within 7 days. The aim of this study was to evaluate the challenges in and lessons learned during the implementation of the 1-3-7 strategy in China so far.MethodsThis qualitative study was conducted in two provinces in China: Gansu province (northwestern China) and Jiangsu province (southeastern China) in 2014. Key informant interviews (n = 6) and in-depth interviews (n = 36) about the implementation aspects of the 1-3-7 strategy were conducted with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels.ResultsBroad themes related to the challenges in and lessons learned during the implementation of the 1-3-7 strategy were identified according to: case reporting within 1 day, case investigation within 3 days, focus investigation within 7 days, and the overall strategy. The major challenges outlined were related to respecting the timeline of surveillance procedures, the absence of or difficulties in following guidelines on conducting focus investigations, diagnostics, and the increasing number of returning migrant workers from malaria-endemic countries. Important lessons learned revolve around the importance of continuous capacity building, supervision and motivation, quality control, information technology support, applied research, governmental commitment, and intersectoral collaboration.ConclusionsSurveillance is a key intervention in malaria elimination programs. The Chinese 1-3-7 strategy has already proven to be successful but still needs to be improved. In particular, dealing appropriately with imported malaria cases through the screening of migrant workers from malaria-endemic countries is essential for achieving and sustaining malaria elimination in China. China has perfect preconditions for successful malaria elimination provided political commitment and financial investment are guaranteed. The 1-3-7 strategy may also be considered as a model for other countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0188-8) contains supplementary material, which is available to authorized users.

Operational Coverage and Timeliness of Reactive Case Detection for Malaria Elimination in Zanzibar, Tanzania

“…During implementation of the 1-3-7 malaria surveillance strategy in China (which likewise requires case reporting within 1 day), the reporting of unconfirmed malaria cases was not considered problematic as long as the notification triggered further investigations including laboratory confirmation by day 3. 17 Ensuring universal availability of diagnostic confirmation, promoting the use of diagnostic tests at all levels, and providing the option to request for a reconfirmation of a case, for example, by a DMSO, could contribute to narrowing the identified gap. In a setting with microscopy capacity, a sample collected on a slide can be diagnosed on return of a temporarily absent microscopist.…”

“…In the context of China's 1-3-7 malaria surveillance, a qualitative study suggested that better transport, calling and making appointments in advance of investigations to avoid absences, and an increase in community acceptance may improve timeliness. 17 In Zanzibar, a replacement of the currently required in-person review of each case at the notifying HF, for example, with a smart phone-based interface allowing the transmission of individual patient details, may likewise improve timeliness. Inperson visits to all HFs, including those not notifying any cases, on a scheduled basis rather than for each notified case, might improve notification completeness and timeliness.…”

Malaria elimination using the 1-3-7 approach: lessons from Sampov Loun, Cambodia

“…4 President's Malaria Initiative/Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 5…”

“…1). The 1-3-7 strategy was initially developed and implemented in China in 2012 [5][6][7] and has since been adapted to the local contexts in several country settings in Southern Africa and Southeast Asia [8][9][10].…”

Malaria Elimination in the People’s Republic of China: Current Progress, Challenges, and Prospects

“…Following the implementation of this 1-3-7 model, local malaria transmission was interrupted effectively in most parts of China, which accelerated the malaria elimination process [20,21,36]. Based on this success, the 1-3-7 model was recommended by WHO as an example for malaria surveillance model at elimination stage, in "Strategy for malaria elimination in the Greater Mekong Subregion: 2015-2030" and "Malaria surveillance, monitoring & evaluation: a reference manual" [37,38].…”