Scaling up malaria elimination management and leadership: a pilot in three provinces in Zimbabwe, 2016–2018

Abstract

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.

Quality Improvement in Public-Private Partnerships in Low- and Middle-Income Countries: A Systematic Review

“…Ongoing sharing of meaningful data and authentic lessons learned were described as common bene ts of collaborative QI programs. Team members valued the opportunities for peer-to-peer learning and the ability to learn directly from others working on similar projects in different settings (31,33,42,52,75,81,88,94,107,110,(118)(119)(120)(121). QI tools could be applied to a wide variety of disciplines, and the teams bene tted from building QI capacity and learning techniques rather than focusing solely on one improvement project (33, 45,…”

“…Many authors noted that data must be relevant to the local context as QI indicators in LMIC can often be different from those in high-income settings (13). Some authors discussed the need to develop better quality indicators (31), or look beyond traditional metrics to identify data that are important and make sense in the local context (sense-making) (72, 138, 139).…”

Is malaria elimination a distant dream? Reconsidering malaria elimination strategies in Zimbabwe

“…However, these measures face emerging impediments leading to malaria resurgence. Firstly, operational challenges such as shortage of resources, low or non-response to field challenges including high refusal of indoor residual spraying, competing programmes and activities such as farming and food distributions demanding same resources (i.e human and time), lack of political will [ 5 ], inconsistent social and behaviour change messaging threatening the success of the programme and poor programme promotion and awareness strategies [ 6 ]. Vector control strategies involve indoor residual spraying, case management and insecticidal treated nets.…”

“…Vector control strategies involve indoor residual spraying, case management and insecticidal treated nets. These are major components of integrated vector management (IVM) that encounter challenges including shortage of spraying commodities and supplies including personal protective equipment and pump spares, inadequate transport, outdated malaria stratification map [ 7 ], insufficient funding and partner support. Also, case management is predominantly used for malaria diagnosis and treatment.…”

Strengthening Management, Community Engagement, and Sustainability of the Subnational Response to Accelerate Malaria Elimination in Namibia

“…13 Although the underlying frameworks have been deployed individually in other countries in Asia Pacific and southern Africa, this was the first time they were implemented in the same country. 14 Joint implementation of these approaches offers lessons in improving leadership and management of malaria elimination programs by subnational health teams in the context of reduced donor financing, stretched human resources, and the COVID-19 pandemic in a rural setting in Namibia that can also be applied to other countries with similar challenges.…”