• Most programmes operated in a decentralized health system, which in some cases led to greater engagement in malaria elimination by subnational health offices and communities • Most programmes were integrated, where malaria programme services were delivered through the system of general health services. Integration was overall a negative experience for most malaria programmes because staff were often given too many roles and responsibilities that were not clearly defined • During the early period of transition to decentralized and/or integrated programs, challenges were faced in maintaining quality and execution of interventions • Accountability for programme impact was not clear for most programmes • Motivation is important to maintain quality of interventions and different groups are and can be incentivized in different ways • Sustained capacity building and strong supervision are key to successful elimination • Working with other sectors to share information and develop and implement interventions has led to greater effectiveness in surveillance, prevention and targeting |