Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique.
Health Policy Plan. 2010 Sep;25(5):372-83. doi: 10.1093/heapol/czq008. Epub 2010 Feb 21.
Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. We aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe.
Using a qualitative case study methodology, we undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. We used an analytical framework that distinguished three broad categories: interests, ideas and events.
A disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organizations, bilateral donors and international NGOs supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution.
Both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas slowed or prevented the uptake of ITNs. Policy makers needed more than evidence from trials to change from the time-honoured IRS strategy that they perceived was working. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.
室内滞留喷洒（IRS）和经杀虫剂处理的蚊帐（ITN）是两种主要的疟疾控制策略，其成本和效果相似。我们旨在描述最近在莫桑比克、南非和津巴布韦关于使用这两种策略的政策发展情况。
采用定性案例研究方法，我们于 2004 年 5 月至 2005 年 3 月对来自关键信息提供者的进行了半结构化访谈，开展了文件审查，并制定了关键事件的时间表。我们使用了一个分析框架，将其分为三个广泛的类别：利益、想法和事件。
不同利益和想法的混合减缓了 ITN 在莫桑比克和津巴布韦的采用速度，并阻止了南非采用 ITN。大多数受访者强烈倾向于使用一种策略而不是另一种策略。在所有三个国家中，国家政策制定者都赞成 IRS，只有在莫桑比克，国家研究人员才支持 ITN。赞成 IRS 的外部利益包括供应杀虫剂的制造商和反对环境法规的团体。支持 ITN 的有国际研究网络、多边组织、双边捐助者和国际非政府组织。研究证据、当地条件、物流可行性、以往经验、对外界想法的反应、社区接受度、政府和非政府组织的作用以及喷洒杀虫剂的危害影响了策略的选择。种族隔离的结束使得强烈支持 IRS 的南非能够影响该地区，在莫桑比克和津巴布韦，洪水为 ITN 的分发提供了有利条件。
IRS 和 ITN 都在综合疟疾媒介管理中占有一席之地，但赞成 IRS 的利益和想法减缓或阻止了 ITN 的采用。政策制定者需要的不仅仅是来自试验的证据，才能改变他们认为有效的久经考验的 IRS 策略。那些打算推广新政策（如 ITN）的人应该检查推动关键利益相关者和自己机构的利益和想法，并确定思维转变或志同道合者之间的联盟是否可能。
