As a partner to countries across Africa seeking to reduce and eliminate malaria, MACEPA works closely with Ministries of Health and national malaria control programs to support implementation of proven interventions for malaria control and prevention and to test innovative new strategies for malaria elimination. As part of this ongoing effort, MACEPA conducted wide-ranging stakeholder assessments in Ethiopia, Kenya, Senegal, and Zambia between November 2014 and June 2015, interviewing the people engaged in malaria elimination in each country. Through these interviews we aimed to identify challenges and opportunities—technical, operational and financial—to the scale up of innovative strategies and to generate analysis that could inform the development of national policies and strategies.
MACEPA worked with PATH offices in each country to create interview lists that reflected the variety of partners involved in malaria decision-making and program implementation. 125 stakeholders were interviewed in total, including policymakers, donors, regulators, private sector representatives, community-level influencers, NGO staff, procurement officials, and medical personnel. During interviews, we asked about each country’s readiness to introduce and bring to scale new tools and approaches and about additional resources that could accelerate progress toward national elimination targets or increase the prominence of malaria elimination on national health agendas.
Stakeholders talked a lot about building strong malaria governance systems for elimination. They emphasized the importance of a sense of ownership and commitment to a country’s malaria initiatives and a defined architecture to ensure coordinated planning and implementation. In Senegal, stakeholders said that the national framework for partner coordination—the Cadre de Concertation des Partenaires de Lutte contre le Paludisme (CCPLP)—has been instrumental in facilitating consensus-building around malaria policy and strategy goals and praised Senegal’s malaria control program, the Programme national de lutte contre le paludisme (PNLP), for its sure-footed implementation of Senegal’s malaria strategic plan.
Stakeholders also underscored the need to formalize and strengthen regional mechanisms for malaria governance. Regional coordination was a key theme in Zambia, which shares borders with eight malaria endemic countries. Many stakeholders in Zambia said that the Elimination 8 regional initiative for malaria elimination in sub-Saharan Africa, which counts Zambia as a member, will be key in promoting regional coordination in the years ahead.
We heard from many stakeholders that malaria elimination will require informed, evidence-based decision making about where to deploy new malaria interventions and how to combine them with traditional interventions for maximum impact. In Zambia, which is now finalizing its first-ever malaria elimination strategy, stakeholders said that technical indicators for malaria burden and importation risk should help guide intervention targeting. Many stakeholders in Zambia felt that drug-based parasite clearance strategies should be a component of the upcoming elimination strategy. Stakeholders in all countries said that community health workers will be critical for implementing malaria elimination strategies. Community health workers already provide community level malaria diagnosis and treatment, they noted, and they will be crucial partners for ambitious parasite clearance and case investigation strategies in the future.
MACEPA’s stakeholder analyses are intended to help illuminate the way forward—and to highlight the progress already made—in four African countries that, despite considerable differences in malaria epidemiology and climate, are advancing together toward malaria elimination. The results and underlying data from this first round of stakeholder analyses will serve as a baseline for MACEPA’s ongoing analysis of the enabling environment for national malaria policy and implementation efforts. MACEPA planning to conduct the next round of stakeholder analysis interviews in approximately three years to examine how perceptions and prioritization among stakeholders have changed over time.