Challenges to the implementation of malaria policies in Malawi

Abstract

Background Despite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing malaria policies in Malawi from the perspective of key stakeholders in the country. Methods In this qualitative study, we conducted in-depth interviews with 27 key informants from April to July 2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling techniques were used to identify key informants including malaria researchers that were policy advisors, policy makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative content analysis approach. Results Participants identified three main categories of challenges to the implementation of malaria policies. First structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The third category is the inadequately informed policy development and includes lack of platforms to engage with communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting policy uptake by communities. Conclusions Policy makers should recognize that inadequate support of policy objectives leads to an implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but rather as interactive processes shaping each other. Support for health policy and systems research should be mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria policies should also be conducted to address these challenges and support the shift from the paradigm of malaria prevention and control to elimination in Malawi.

Prevalence and determinants of malaria infection among children of local farmers in Central Malawi

“…This finding raises concerns regarding whether long-lasting insecticidal nets (LLINs) and sulfadoxine-pyrimethamine preventive treatment programmes, that were introduced in the study area in 2007 and 2006, respectively and were still running in 2019, are associated with the reduction in malaria prevalence. But a study by Mwendera et al [29] observed that malaria reduction programmes in Malawi are facing various challenges, including the failure to understand the social cultural context in the uptake of the malaria control programmes. Another study in Malawi suggested that a limited number of health workers and poor prescription of anti-malarial drugs were some of the challenges that constrain malaria prevention in Malawi [30].…”

Prevalence and Determinants of Malaria Infection Among Children of local farmers in Central Malawi

“…This finding raises concerns regarding whether the long-lasting insecticidal nets (LLINs), and Sulfadoxine Pyrimethamine preventive treatment programs that were introduced in the study area in 2007 and 2006 respectively are associated with the reduction in malaria prevalence. But a study by Mwendera et al (2019) observed that malaria reduction programs in Malawi are facing various challenges, including the failure to understand the social cultural context in the uptake of the malaria control programs.…”

A qualitative exploration of the experiences of community health animation on malaria control in rural Malawi

“…Malawi has not been spared the devastation, current statistics present it as an area of high prevalence [9]. Plasmodium falciparum is the most prevalent parasite responsible for close to 5 million cases annually in a population of roughly 17.5 million people [2,10].…”

“…Plasmodium falciparum is the most prevalent parasite responsible for close to 5 million cases annually in a population of roughly 17.5 million people [2,10]. Much like in other parts of sub-Saharan Africa, there has been a decrease in the number of cases since the adoption and implementation of the RBM strategy for malaria control, the trend however still remains worryingly high [2,9]. The population most at risk are women and children, and specifically those residing in desolate conditions in remote and rural areas with poor access to preventative and treatment interventions [9][10][11].…”