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Table 2 Key gaps between demand and supply of malaria control interventions and program components

From: Understanding challenges to malaria elimination in Nepal: a qualitative study with an embedded capacity-building exercise

Areas

Demand

Supply

Local perception of the gap

LLIN

There is a high demand for LLIN at community level. Even existing LLIN need replacement as many may have worn out. The willingness to pay for LLINs is low, however, especially among the disadvantaged groups

The last distribution of the LLINs by the district authorities was 4 years before. Currently, only high-risk groups, such as infants and pregnant mothers in high-risk geographic areas them. The government attempted to provide LLINs to disadvantaged groups a few years ago with limited success

There is an excess demand for LLIN

IRS

There is a high demand for IRS at the community level, especially in high-risk areas, such as the ones near the forest belt and brick factories

In suburban areas, households are buying IRS themselves to spray at community level as they suspect the quality of IRS sprayed by the government

Supply of IRS is low at community level and the district public health offices have targeted specific areas to spray each year (free of cost)

There is an excess demand for IRS

Diagnosis and treatment

There is a high demand for the diagnosis and treatment of malaria, mainly due to increased awareness among the population

Many health facilities are equipped with basic diagnosis and treatment services. However, microscopy services are available only in a few health facilities, as are laboratory chemicals

There is a lack of microscopy services for testing blood samples in health facilities

Human resource

The communities seek qualified health workers in the public health facilities and either seek alternatives (i.e., the private providers) or forego diagnosis and treatment when they are not available

There exists a shortage of skilled and trained health workers in all health facilities. The existing human resources, including the few lab technicians, health assistants, have limited training on malaria diagnosis and treatment. The female community health volunteers also lack malaria-specific knowledge

There are insufficient number of health workers and in cases where they are present, they are insufficiently trained on the diagnosis and treatment of malaria