To eliminate malaria, TDR recommends thinking and acting locally

WHO’s TDR initiative shares lessons learned for the malaria endgame 

Malaria prevention, control and elimination depend on getting to grips with local problems, finding solutions and sharing locally generated ideas. On World Malaria Day, research results from 10 TDR-supported studies and an editorial on lessons learned for the malaria endgame have been published in the journal Public Health Action.

The studies were developed through TDR’s Structured Operational Research and Training Initiative (SORT IT) and provide valuable lessons for strengthening health systems for malaria elimination in Botswana, Namibia, South Africa and Swaziland – four south African countries with the goal of eliminating malaria within the next decade.

In the publication supplement, editor Professor Maxine Whittaker writes: “Implementation research helps identify what modifications need to be made for the various contexts – ecosystems, social, political, geographical, health systems, cultural – to reach a pre-elimination and elimination agenda.”

Building research capacity is a critical dimension to addressing the challenges and implementing proven approaches and interventions in the local context, she emphasizes.

She says: “Lessons learned from SORT IT are important both globally and locally. Globally, because the authors of the studies demonstrate the role of operational research and investment in human capital needed to achieve malaria elimination. Locally, because local challenges in implementation will need to be addressed if the global ambition of malaria eradication by 2040 is to be achieved.”

To achieve the malaria elimination targets, country health systems and malaria programmes need to better understand the barriers and identify adapted, sustainable solutions to them – and SORT IT is a valuable tool in accomplishing this, she notes.

The research portfolio

The studies covered a range of malaria prevention and control areas, including health information systems and their links to disease surveillance and response; collection of quality data and better access to reliable malaria information for stronger accountability on progress toward objectives; adequate stocks of diagnostics and medicines to detect and treat malaria at every level of care; changing vector behavior and mosquito control strategies; and the role of the community and the competency of front-line health workers.

Some specific examples:

• In Botswana and Swaziland, research teams focused on challenges in maintaining information systems such as poor record-keeping, data integrity, and poor capacity and commitment to use of the data to identify problems and generate ideas for solutions.
• In Swaziland, researchers explored the role of travelers related to malaria detection, and documented the low uptake of preventive practices or awareness of health risk among the population.
• In Namibia, maintaining community support of indoor residual spraying (IRS), for example, was identified as critical to achieving the end game.

Read the articles that resulted from this SORT IT programme

The value of partnerships

The specific SORT IT programme that led to these publications included a partnership of TDR with the WHO Regional Office for Africa and Global Malaria Programme, Ministries of Health, in-country and regional universities, non-governmental organizations and, in one country, the private sector. The training workshops and subsequent mentoring through the research process took place between 2015 and 2016. The publishing and sharing of findings and experience gained – as demonstrated in this supplement – are hallmarks of the SORT IT model.

The breadth of partnerships developed within each country for this research “augurs well for the future,” says Whittaker.

Such partnerships for capacity building, to end diseases of poverty, and improve health and well-being are cornerstones of the Sustainable Development Goals, which implicitly call upon countries to work together for the global public good.

Sustained and substantial political, scientific and community efforts are required to achieve the malaria endgame. Working with our partners, TDR is committed to the spirit of World Malaria Day and efforts that move us forward towards elimination.