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

• Published in: Malaria journal Vol. 20; no. 1; p. 428
• Main Authors: Ruwanpura, Varunika, Neukom, Josselyn, Grietens, Koen Peeters, Price, Ric N, Thriemer, Kamala, Lynch, Caroline A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30-10-2021; BioMed Central; BMC
• Subjects: Best practices; Cambodia; Care and treatment; Data analysis; Data collection; Decision making; Diagnosis; Documentation; Drug dosages; Economics; Ethiopia; Global health; Global Health - statistics & numerical data; Governance; Guidelines as Topic; Health policy; Health Policy - legislation & jurisprudence; Human diseases; Indonesia; Interviews; Laws, regulations and rules; Malaria; Malaria elimination; Malaria health policy; Malaria, Vivax - diagnosis; Malaria, Vivax - prevention & control; Medical diagnosis; Pakistan; Papua New Guinea; Plasmodium vivax malaria; Policies; Policy Making; Policy pathways; Population number; Public health; R&D; Radical cure; Research & development; Socioeconomic aspects; Socioeconomics; Sri Lanka; Vector-borne diseases; Vietnam; Working groups; Papua New Guinea; Vietnam; Pakistan; Cambodia; Sri Lanka; Ethiopia; Indonesia; Pacific Rim; Asia; Malaria health policy; Malaria elimination; Plasmodium vivax malaria; Radical cure; Policy pathways
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-021-03959-w

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.
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".
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.
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.