Background: Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos.
Methods: A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods.
Results: Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate.
Conclusions: This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.
Keywords: Capacity building; Challenges; Leadership; Malaria elimination; Operations; Programme management; Service delivery; Zimbabwe.
Conflict of interest statement
The authors declare that they have no competing interests.
The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes.Malar J. 2016 Sep 22;15(1):488. doi: 10.1186/s12936-016-1518-9. Malar J. 2016. PMID: 27659770 Free PMC article.
A review of progress towards sub-national malaria elimination in Matabeleland South Province, Zimbabwe (2011-2015): a qualitative study.Malar J. 2018 Apr 3;17(1):146. doi: 10.1186/s12936-018-2299-0. Malar J. 2018. PMID: 29615043 Free PMC article. Review.
Medical Error Prevention.2020 Feb 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. StatPearls. 2020 Jan–. PMID: 29763131 Free Books & Documents. Review.
What is community engagement and how can it drive malaria elimination? Case studies and stakeholder interviews.Malar J. 2019 Jul 17;18(1):245. doi: 10.1186/s12936-019-2878-8. Malar J. 2019. PMID: 31315631 Free PMC article.
Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review.Malar J. 2017 Jan 3;16(1):10. doi: 10.1186/s12936-016-1667-x. Malar J. 2017. PMID: 28049486 Free PMC article. Review.