Abstract:
BACKGROUND: Policy decisions for malaria control are often difficult to make as decision-makers have to carefully
consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the
factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing
an inclusive malaria decision analysis support tool (MDAST).
METHODS: Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya,
Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders,
targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to
have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate.
RESULTS: Important findings aggregated across countries included a belief that donor preferences and agendas were
exerting too much influence on malaria policies in the countries. Respondents on average also thought that some
relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a
particular country were not being given enough consideration in malaria decision-making. Factors found to influence
decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health
and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides.
CONCLUSION: Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental
impacts as well as cost implications of different intervention strategies. Further engagement of government legislators
and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence,
sustain interventions and consolidate current gains in malaria.
