New research suggests that making use of practical experience can have a transformative effect on the success of malaria surveillance as a core intervention (SACI) in moderate to high malaria transmission countries. Malaria Consortium researchers were part of a scientific group that collated and analysed the experiences of national malaria control programmes and partners in countries which were early adopters of surveillance-driven decision-making. The study findings were published in the American Journal of Tropical Medicine and Hygiene.
Recently, gains in the fight against malaria have been threatened by antimalarial and insecticide resistance, invasive vectors, human population growth, stagnant funding and the COVID-19 pandemic. These developments have resulted in excess malaria deaths highlighting the need for countries to define strategies informed by data and evidence to tackle malaria at their specific sub-national levels.
As part of the research, representatives from the National Malaria Control Programmes of Guinea, Mozambique, Senegal, Zambia, as well as international non-governmental organisations and funding partners, shared what SACI means in their contexts. They also gave recommendations on how to transform surveillance into an intervention in moderate to high transmission settings.
Implementers stated that regularly using surveillance mechanisms to gather and review data, involving personnel at all levels of the health system and securing government buy-in, were crucial for effective surveillance. Through better analysis and the strategic use of quality data as part of surveillance, countries can pinpoint where to deploy the most effective malaria control tools for maximum impact.
The need for information to target malaria control efforts has driven the recognition of SACI and a wealth of detailed operational guidance exists for the use of this intervention in low to very low transmission settings, including recommendations for case investigation, reactive case detection and focus investigation. But further guidance is needed to fully operationalise the concept of SACI in moderate and high transmission settings, countries in which Plasmodium falciparum prevalence is above five percent, as surveillance implementation can be challenging in such settings.
National malaria control programmes in endemic countries are gaining rich experience and understanding in the practical application of malaria SACI and the knowledge and experience of these programmes is making a significant contribution to the evidence base around malaria surveillance.
Effective use of surveillance as a core intervention depends on coordinating many interdependent processes and on the engagement of stakeholders from across the ministry of health and at all levels of the health system, as well as international financial and technical partners.
Countries that have successfully deployed surveillance have implemented basic training in the use of reporting tools (usually DHIS2) for personnel capacity building in surveillance at all levels. Regular data-driven activities improve data quality and data timeliness which allows stakeholders to understand trends, respond to programme needs, foster a culture of data use and to develop a strategic response.
Utilising community health workers (CHWs) to improve case management and identification is also an integral part of successful surveillance. In programmes where CHWs diagnose and treat a substantial proportion of malaria cases at the community level, and their reporting is integrated into a routine information system, community case management becomes an example of surveillance as a core intervention, leading to more timely decision-making at the local level. The research also suggests government interventions, including providing adequate pay to CHW retention, are important.