Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania

Abstract

Background: Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST).

Methods: Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate.

Results: Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides.

Conclusion: Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.

Figure 1

Meetings with agency with main responsibility for malaria control policies.

Figure 2

Factors determining national malaria control policies.

Figure 3

Objectives for malaria control policies.

Figure 4

Importance of indicators for policymakers.

Figure 5

Risks for human health impacts of malaria control activities.

Figure 6

Deciding on the use of nets (ITNs and LLINs).

Figure 7

Deciding on the use of IRS (pyrethroids or DDT).

Figure 8

Deciding on the use of larvicides.

Figure 9

Deciding on the use of ACT.

Figure 10

Deciding on the use of IPTp and IPTi.

Figure 11

Diagnostic priorities for malaria.