Table 3 Commonly reported operational challenges and evidence gaps in malaria prevention and control, by thematic area
Thematic area | Most common operational challenges identified | Key evidence gaps reported |
|---|---|---|
Prevention | ITNs • Sustaining high coverage in high burden areas and ensuring coverage among highest risk populations • Routine distribution and distribution to the last mile • Low ITN use in populations with high access • Shorter than expected durability IRS • How to determine what insecticide to spray, and when/where to deploy IRS LSM • Engagement of communities on carrying out and maintaining LSM • Not enough trained human resources for mapping breeding sites • Lack of M&E frameworks and indicators for LSM; general insufficient monitoring of LSM programmes Crosscutting • Implementation of insecticide resistance management | ITNs • Insufficient evidence on effectiveness of CE/SBC approaches to improve ITN use • Understanding of barriers and facilitators to ITN use (specifically social factors at community level, in the context of provider-patient interactions, and in low transmission settings) • ITN durability under routine conditions IRS • Best practices for IRS withdrawal and transition strategies to prevent case resurgence • Impact of IRS and focal or reactive IRS on malaria burden, transmission, and insecticide resistance • Cost-effective and cost-saving approaches for IRS LSM • Impact of LSM on malaria burden and transmission in different contexts and transmission settings Crosscutting • Effective delivery mechanisms and innovative approaches to reach and ensure sustained coverage in hard-to-reach populations • Effectiveness and cost-effectiveness of vector control intervention combinations • Understanding around the essential data elements needed and at what granularity to inform and improve targeting and stratification of interventions |
Chemoprevention | IPT • Delayed first antenatal care (ANC) visit or incomplete attendance at recommended ANC visits • Access to ANC/IPTp services (e.g., transport, cost) • Health care providers low adherence to IPTp guidelines/lack of training on IPTp guidelines SMC • Measurement of coverage due to inaccurate denominators • High cost of implementation | IPT • Effective strategies for achieving high coverage and efficient delivery of IPTp • What transmission threshold to use to inform transition away from IPTp delivery • Factors that have impeded scale-up of perennial malaria chemoprevention (PMC) and strategies for addressing the barriers • Limited understanding of the operational feasibility and best delivery platform for PMC SMC • Effectiveness and cost-effectiveness of SMC, particularly in use among school age children and geographical coverage outside the Sahel • Effective strategies for achieving high coverage of SMC in target areas • When and where to use SMC to reduce burden and when and how to determine when to scale-up or scale-down SMC MDA • Optimum methods for implementing MDA in different settings/contexts |
Case management | Overarching • Poor access to health care services • Caregivers’/patients’ perception of poor-quality services (e.g., long wait times, stockouts, insufficient providers) • Health care providers’ poor adherence to national case management guidelines • Challenge with commodity quantification due to poor quality or limited availability of stock data; limited capacity of health facility staff in supply chain management, reporting and use of stock data; and use of parallel sources/mechanisms for quantification and distribution Community case management • High turnover of community health workers (CHWs) and insufficient coverage of CHWs • CHWs’ poor adherence to national treatment guidelines • Poor linkages between communities and CHWs • Weak supervision of CHWs • Poor data quality at community level and lack of integration of community data into national HMIS Private sector case management • Poor or lack of engagement, coordination, and integration between private and public sector for case management and reporting • Poor adherence to national treatment guidelines | Overarching • Effective strategies for improving health care providers’ adherence to national treatment guidelines (beyond training and supervision) • Effective strategies for addressing stockouts Community case management • Evidence on the quality of integrated community case management provision by CHWs Private sector case management • Effective strategies and policies for strengthening collaboration of the private sector in malaria case management and reporting into the national HMIS |
Surveillance, monitoring, and evaluation | SME/HMIS • Poor quality HMIS data • Limited capacity in surveillance, monitoring and evaluation/operational research, particularly in data analysis, interpretation and use of data for programmatic decision-making • Poor culture of data use • Inadequate supervision for data reporting and limited or inconsistent administration of data quality audits • Fragmented/poorly integrated data systems • Limited knowledge/capacity around how best to stratify to inform subnational targeting of interventions Entomological monitoring and surveillance • Limited coverage of entomological surveillance data • Limited capacity for conducting entomological. surveillance and for the analysis, interpretation and use of vector data • Fragmented systems for entomological data capture | SME/HMIS • Guidance on minimum data needs to inform real-time programmatic decision-making, particularly for malaria surveillance systems in low transmission settings and for informing subnational targeting of interventions • Identification and characterization of key populations, including accurate denominators for populations at risk to improve accuracy of intervention coverage measurement • Understanding the current performance of surveillance systems, particularly in low transmission settings • Optimal/effective surveillance system approaches for malaria elimination Entomological monitoring and surveillance • Limited evidence on An. stephensi spread in new geographical areas, including information on breeding, resting, and biting behaviours, and susceptibility to insecticides |
Community engagement/social and behaviour change | • Insufficient monitoring and evaluation of CE/SBC activities • Limited technical capacity in CE/SBC | • Effectiveness and cost-effectiveness of CE/SBC interventions on malaria intervention uptake in different transmission settings and contexts • Evidence on duration of the effectiveness of malaria CE/SBC interventions |
Crosscutting | • Insufficient funding to achieve high coverage of interventions • Supply chain delays or failures due to a myriad of challenges • Insufficient number of trained human resources to provide sufficient coverage of health care services, prevention interventions, and SME | • Evidence on effective multi-sectoral strategies for malaria prevention • Evidence on effectiveness and cost-effectiveness of different malaria intervention packages |