Strengthening the health systems at national level for malaria elimination in the Greater Mekong Subregion countries: a qualitative study.

BACKGROUND

Countries in the Greater Mekong Subregion (GMS) have committed to eliminating malaria by 2030. The success of a national malaria programme's transition from malaria control to elimination is dependent on the readiness of the health system to implement malaria elimination strategies. Understanding the readiness of health systems and what needs to be adapted is key to identifying barriers in achieving malaria elimination goals. This study aims to assess health system needs for malaria elimination, identify national-level barriers to effective implementation, and provide recommendations for policymakers and programme managers to strengthen strategies through a health system perspective.

METHODS

A multi-country qualitative study was conducted in the GMS. Semi-structured interviews were conducted with 39 stakeholders including national malaria policymakers (n = 5), basic health staff from Ministries of Health (n = 12), managers and field supervisors from malaria implementing partners (n = 16) and personnel from technical agencies (n = 6). Reflexive thematic analysis of national level health system requirements was carried out aligned with themes adapted from the World Health Organization (WHO) health system building blocks.

RESULTS

Stakeholders discussed that malaria elimination required inputs from all six WHO health system building blocks at the national level. Major inputs included strong political commitment, targeted interventions for high-risk groups, reliable forecasting and supply chains, skilled workforce, and robust quality assurance. Furthermore, National Malaria Elimination Programmes should expand access to diagnostic kits and medicines and enforce mandatory glucose-6-phosphate dehydrogenase enzyme testing. Stakeholders identified health system barriers such as the lack of targeted interventions in high-risk groups in national policies, incomplete reporting from private sector, lack of experienced workforce for elimination, administrative constraints in supply chain, declining malaria funding from international donors, and poor compliance to regulations for malaria elimination. For malaria elimination in the GMS to succeed, comprehensive health system strengthening across all six building blocks is essential.

CONCLUSIONS

National programmes must assess national health system readiness for malaria elimination to avoid inefficiencies, financial strain, and unattended gaps, using a systems thinking approach. This study also highlighted the importance of evaluating the national programmes from the perspective of health system needs and readiness for successful transitioning from control to elimination phase.