The Health System’s Challenge to Deliver Malaria Prevention and Treatment

Author(s): Don De Savigny1
Affiliation(s): 1Epidemiology and Public Health, Swiss Tropical Institute, Basel, Switzerland
Key issues:

Effective control of malaria in Africa faces many challenges and bottlenecks. The dramatic increase in financial resources for malaria control provided by recent Global Health Initiatives and new partnerships for financing at country level have improved the prospects of having sufficient commodities for malaria prevention (long-lasting insecticidal nets, insecticides for indoor residual spraying) and treatment (artemisinin combination therapy and other drugs). As this higher-level constraint resolves, another array of constraints are quickly becoming evident. These include large-scale procurement of commodities once financing is available, and the delivery of these commodities in programmes that actually reach the population in need. These constraints are all health system constraints. Failure of countries and donor partners to invest wisely in health systems development have resulted in the current frustration to meet Millennium Development and other international and national goals.

Objective(s): This presentation will examine the common health system weaknesses that currently impede effective national-scale malaria prevention and treatment. Under health systems dimensions of stewardship, resources, financing and programme delivery, key weaknesses revolve around: policies and guidelines; tendering and procurement; public-private partnerships; human resources, training and supervision; decentralization and ownership; national and local planning, priority setting and resource allocation; population access and targeting; provider compliance; consumer adherence; home care and household behaviours; monitoring and evaluation.
Meeting challenges: There are a number of strategies for both quickly scaling up equitable access and coverage of malaria interventions that can temporarily avoid these system constraints (e.g. campaign approaches for preventive interventions), yet help build systems for more sustainable continuous availability of quality interventions through routine systems (integration). This presentation will examine some recent successes in such approaches.
Conclusion (max 400 words): When it comes to achieving malaria control, health system strengthening is ignored at our peril. There are a number of system strengthening strategies that have been shown to work, but all require political commitment from all partners.

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