Mwendera Chikondi A, de Jager Christiaan, Longwe Herbert, Kumwenda Save, Hongoro Charles, Phiri Kamija, Mutero Clifford M
University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001, South Africa.
ICAP at Columbia University, Mailman School of Public Health, Pretoria, South Africa.
BMC Health Serv Res. 2019 Mar 27;19(1):194. doi: 10.1186/s12913-019-4032-2.
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.
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.
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.
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.
尽管有疟疾预防举措，但疟疾仍是马拉维的一个主要健康问题，尤其是对孕妇和五岁以下儿童而言。为减轻疟疾负担，马拉维于1984年设立了首个国家疟疾控制项目。循证政策的实施促使疟疾流行率从2010年的43%降至2017年的22%。在本研究中，我们从该国关键利益相关者的角度探讨了马拉维实施疟疾政策面临的挑战。
在这项定性研究中，我们于2015年4月至7月对27名关键信息提供者进行了深入访谈。当主题饱和时，我们停止对新参与者进行抽样。采用目的抽样和滚雪球抽样技术来确定关键信息提供者，包括担任政策顾问的疟疾研究人员、政策制定者、项目管理人员和其他关键利益相关者。访谈以英语进行，录音并转录，然后导入QSR Nvivo 11进行编码和分析。数据采用定性内容分析法进行分析。
参与者确定了实施疟疾政策面临的三大类挑战。首先，结构性挑战包括资源不足、缺乏训练有素的工作人员、对工作人员的监督和指导不力以及政府部门的人员流动。第二个挑战是政策的单方面实施。第三类是政策制定过程中信息不足，包括缺乏与社区互动的平台、政策制定的自上而下方式以及对影响社区政策接受度的社会文化因素缺乏了解。
政策制定者应认识到对政策目标的支持不足会导致实施差距。因此，政策制定和实施不应被视为相互独立的，而应被视为相互塑造的互动过程。应调动对卫生政策和系统研究的支持，以加强卫生系统。还应针对具体疟疾政策实施挑战进行详细评估，以应对这些挑战，并支持马拉维从疟疾预防和控制模式向消除模式转变。
