Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
Independent Consultant, Ho Chi Minh City, Vietnam.
Malar J. 2021 Oct 30;20(1):428. doi: 10.1186/s12936-021-03959-w.
The changing global health landscape has highlighted the need for more proactive, efficient and transparent health policy-making. After more than 60 years of limited development, novel tools for vivax malaria are finally available, but need to be integrated into national policies. This paper maps the malaria policy-making processes in seven endemic countries, to identify areas where it can be improved to align with best practices and optimal efficiency.
Data were collected during a workshop, convened by the Asia Pacific Malaria Elimination Network's Vivax Working Group in 2019, and subsequent interviews with key stakeholders from Cambodia, Ethiopia, Indonesia, Pakistan, Papua New Guinea (PNG), Sri Lanka and Vietnam. Documentation of policy processes provided by respondents was reviewed. Data analysis was guided by an analytic framework focused on three a priori defined domains: "context," "actors" and "processes".
The context of policy-making varied with available funding for malaria, population size, socio-economic status, and governance systems. There was limited documentation of the process itself or terms of reference for involved actors. In all countries, the NMP plays a critical role in initiating and informing policy change, but the involvement of other actors varied considerably. Available evidence was described as a key influencer of policy change; however, the importance of local evidence and the World Health Organization's endorsement of new treatments and diagnostics varied. The policy process itself and its complexity varied but was mostly semi-siloed from other disease specific policy processes in the wider Ministry of Health. Time taken to change and introduce a new policy guideline previously varied from 3 months to 3 years.
In the medium to long term, a better alignment of anti-malarial policy-making processes with the overall health policy-making would strengthen health governance. In the immediate term, shortening the timelines for policy change will be pivotal to meet proposed malaria elimination milestones.
不断变化的全球卫生格局凸显出对更积极主动、高效和透明的卫生决策制定的需求。经过 60 多年的有限发展，新的间日疟原虫防治工具终于问世，但需要将其纳入国家政策。本文绘制了七个流行国家的疟疾决策制定流程，以确定可以改进的领域，使其与最佳实践和最佳效率保持一致。
数据是在 2019 年由亚太疟疾消除网络间日疟工作组举办的一次研讨会上收集的，并随后对柬埔寨、埃塞俄比亚、印度尼西亚、巴基斯坦、巴布亚新几内亚、斯里兰卡和越南的主要利益相关者进行了采访。对受访者提供的政策流程文件进行了审查。数据分析以一个分析框架为指导，该框架侧重于三个事先确定的领域：“背景”、“参与者”和“流程”。
决策制定的背景因疟疾可用资金、人口规模、社会经济地位和治理制度而有所不同。几乎没有关于流程本身或参与方职权范围的文件记录。在所有国家，国家疟疾规划都在启动和推动政策变革方面发挥着关键作用，但其他参与者的参与程度差异很大。现有证据被描述为推动政策变革的关键因素；然而，地方证据的重要性以及世界卫生组织对新治疗方法和诊断方法的认可程度存在差异。政策流程本身及其复杂性因国而异，但在更广泛的卫生部内，大多与其他特定疾病的政策流程相分离。改变和引入新的政策指南所花费的时间此前从 3 个月到 3 年不等。
从中长期来看，将抗疟决策制定流程与整体卫生决策制定更好地协调一致，将加强卫生治理。在短期内，缩短政策变革的时间线对于实现拟议的消除疟疾里程碑至关重要。
