Opening the policy blackbox: Unravelling the process for changing national diagnostic and treatment guidelines for vivax malaria in seven countries

Varunika Ruwanpura, Josselyn Neukom, Koen Peeters Grietens, Ric N. Price, Kamala Thriemer, Caroline A. Lynch

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Background: The changing global health landscape has highlighted the need for more proactive, efficient and transparent health policy-making. After more than 60 years of limited development, novel tools for vivax malaria are finally available, but need to be integrated into national policies. This paper maps the malaria policy-making processes in seven endemic countries, to identify areas where it can be improved to align with best practices and optimal efficiency. 

Methods: Data were collected during a workshop, convened by the Asia Pacific Malaria Elimination Network’s Vivax Working Group in 2019, and subsequent interviews with key stakeholders from Cambodia, Ethiopia, Indonesia, Pakistan, Papua New Guinea (PNG), Sri Lanka and Vietnam. Documentation of policy processes provided by respondents was reviewed. Data analysis was guided by an analytic framework focused on three a priori defined domains: “context,” “actors” and “processes”. 

Results: The context of policy-making varied with available funding for malaria, population size, socio-economic status, and governance systems. There was limited documentation of the process itself or terms of reference for involved actors. In all countries, the NMP plays a critical role in initiating and informing policy change, but the involvement of other actors varied considerably. Available evidence was described as a key influencer of policy change; however, the importance of local evidence and the World Health Organization’s endorsement of new treatments and diagnostics varied. The policy process itself and its complexity varied but was mostly semi-siloed from other disease specific policy processes in the wider Ministry of Health. Time taken to change and introduce a new policy guideline previously varied from 3 months to 3 years. 

Conclusions: In the medium to long term, a better alignment of anti-malarial policy-making processes with the overall health policy-making would strengthen health governance. In the immediate term, shortening the timelines for policy change will be pivotal to meet proposed malaria elimination milestones.

Original languageEnglish
Article number428
Pages (from-to)1-20
Number of pages20
JournalMalaria Journal
Issue number1
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [INV-010504]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. VR is funded by an Australian Government Research Training Programme stipend from Charles Darwin University and received a travel grant from the Australian Centre of Research Excellence in Malaria Elimination (APP 1134989). KT is funded by a CSL Centenary Fellowship and RNP is a Wellcome Trust Senior Fellow in Clinical Science (200909).

Publisher Copyright:
© 2021, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


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