BACKGROUND : Despite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially
for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first
National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria
prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing
malaria policies in Malawi from the perspective of key stakeholders in the country.
METHODS : In this qualitative study, we conducted in-depth interviews with 27 key informants from April to July
2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling
techniques were used to identify key informants including malaria researchers that were policy advisors, policy
makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and
transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative
content analysis approach.
RESULTS : Participants identified three main categories of challenges to the implementation of malaria policies. First
structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship
of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The
third category is the inadequately informed policy development and includes lack of platforms to engage with
communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting
policy uptake by communities.
CONCLUSIONS : Policy makers should recognize that inadequate support of policy objectives leads to an
implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but
rather as interactive processes shaping each other. Support for health policy and systems research should be
mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria
policies should also be conducted to address these challenges and support the shift from the paradigm of malaria
prevention and control to elimination in Malawi.