Evidence-based policy change for more effective radical cure

My project will propose a modelfor accelerating evidence-based policy change for more effective radical cure (combinedblood and liver stage treatment) for P.vivax malaria to facilitate 2030 regional malariaelimination goals. It investigates how stakeholder networks; policyprocesses and contextual factors shape introductionof effective radical cure. Hierarchy and types of stakeholdersinvolved in national policy making in three countries and how policy decisionsare made in these countries will be evaluated. Investigated contextual factors include further country-specific evidencerequired, the political economy of change, the rationale for change,relevant socio-cultural factors, and the broader impact of a policy changeto countries. The impact of the World HealthOrganization’s (WHO) global malaria treatment recommendations onNational Strategic Plans is also considered.  A comparative case study approach isadopted to undertake analysis of how these direct and indirect factorsinfluence policy decision making in study countries. Three methods will be usedto collect and analyse data: review of malaria policy and related governmentdocuments, semi structured interviews and participant observation of countries’policy meetings.  Three tested policy frameworks areadopted for data analysis: the ‘policy triangle framework’, the ‘3i framework’and Shiffman & Smith’s ‘four factors influencing health policy agenda’ [1-4]. 

P. vivax is one of the most challengingmalaria species to control as it forms dormant liver stages (hypnozoites)that can reactivate weeks or months following an acuteinfection. It has a wide geographic distribution with approximately35% of the world’s population at risk and an estimated 14.3 million casesreported by the Malaria Atlas Project in 2017 [5,6]. The only liver-stage drugcurrently widely available to treat dormant liver forms of P. vivax is primaquine (PQ) usuallyadministered over 14 days. Its widespread use is limited by lowprescription, low adherence and concerns over its safety for administeringto glucose-6-phosphate dehydrogenase deficient patients. Shorter treatmentregimens and new diagnostic tools are now available to overcome theselimitations. However, introducing these into national health systems requires policyrevision. A key determinant of whether and when countriesadopt new regimens is endorsement by the WHO’s Global Malaria Programme aswell as national policy recommendations. At global and national levels,processes by which evidence informs policy are unclear regarding what triggersor what evidence underpins policy change but are vital to understandif countries are to meet current global malaria elimination goals. For thesereasons, my project’s investigation of factors influencing national policyprocesses to propose new interventions for policy revision is needed.     

1.         Walt, G., Health Policy: An Introduction To Processand Power. 1994, Johannesburg: Zed Books.

2.         Shearer, J.C., etal., Why do policies change?Institutions, interests, ideas and networks in three cases of policy reform.Health Policy and Planning, 2016. 31(9):p. 1200-1211.

3.         Shiffman, J. and S.Smith, Generation of political priorityfor global health initiatives: a framework and case study of maternalmortality. The Lancet, 2007. 370(9595):p. 1370-1379.

4.         Walt, G. and L.Gilson, Can frameworks inform knowledgeabout health policy processes? Reviewing health policy papers on agenda settingand testing them against a specific priority-setting framework. HealthPolicy and Planning, 2014. 29(suppl_3):p. iii6-iii22.

5.         WHO. World Malaria Report. 2019  [cited 2020 28/01/20]; Available from: https://www.who.int/publications-detail/world-malaria-report-2019.

6.          Battle, K.E., etal., Mapping the global endemicity andclinical burden of Plasmodium vivax, 2000–17: a spatial and temporal modellingstudy. The Lancet, 2019. 394(10195):p. 332-343.