Capacity of National Malaria Control Programmes to implement vector surveillance: a global analysis

Abstract

Background: Solving the problem of malaria requires a highly skilled workforce with robust infrastructure, financial backing and sound programme management coordinated by a strategic plan. Here, the capacity of National Malaria Control Programmes (NMCPs) was analysed to identify the strengths and weaknesses underpinning the implementation of vector surveillance and control activities by the core elements of programme capacity, being strategic frameworks, financing, human resources, logistics and infrastructure, and information systems.

Results: Across nearly every country surveyed, the vector surveillance programmes were hampered by a lack of capacity and capability. Only 8% of NMCPs reported having sufficient capacity to implement vector surveillance. In contrast, 57%, 56% and 28% of NMCPs had the capacity to implement long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS) and larval source management (LSM) activities, respectively. Largely underlying this was a lack of up-to-date strategic plans that prioritize vector surveillance and include frameworks for decision-making and action.

Conclusions: Strategic planning and a lack of well-trained entomologists heavily hamper vector surveillance. Countries on the path to elimination generally had more operational/field staff compared to countries at the stage of control, and also were more likely to have an established system for staff training and capacity building. It is unlikely that controlling countries will make significant progress unless huge investments also go towards increasing the number and capacity of programmatic staff.

Keywords: Anopheles; Capacity building; Logic framework; Malaria; Needs Assessment; Vector surveillance.

Fig. 1

Framework for vector surveillance which can be used as a basis for conducting a needs assessment of the inputs and activities of vector surveillance programmes

Fig. 2

Relative comparison of the programmatic inputs (y axis) that limit ability of National Malaria Control Programmes to fully implement vector control activities (x axis). Here the bars represent the proportion of countries that indicated each input is limiting

Fig. 3

The subcategories of programme inputs limiting National Malaria Control Programmes to fully implement vector surveillance and vector control interventions. Percentages were calculated using the number of countries that deploy each intervention as the denominator and show the percentage of countries that reported a programme subcategory as limiting

Fig. 4

Components of logistics and infrastructure reported by countries survey participants as limiting National Malaria Control Programme implementation of vector surveillance at the national and subnational levels

Fig. 5

Partners supporting vector surveillance through direct assistance to laboratories, or surveys to monitor LLINs or IRS. Percentages were calculated using the denominator of the number of countries that had laboratory access or undertook LLINs or IRS activities

Fig. 6

The median number of vector control entomology staff per national malaria control programme for countries eliminating malaria compared with those controlling malaria

Fig. 7

Relative composition of staffing across programmatic levels for national malaria control programmes that are controlling or eliminating malaria

Fig. 8

Proportional shortfalls in staffing capacities of national malaria control programmes