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Table 3 Level of decentralization, integration and clarity of line of accountability affecting the national malaria programmes of the nine countries, with year of decentralization and integration if available

From: The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes

 

Centralized vs decentralized health system

Vertical vs integrated malaria programme

Clarity of line of accountability as described in the case-studya

0, +, ++

BTN

Decentralized since 1981 to district, further delegation from districts to subdistrict level beginning in 1990 and scaled up by 1996

Integrated with other vector-borne diseases since 2003

0

CPV

Decentralized to “health delegation” (local health authority) level

Integrated with other infectious diseases

0

MYS

Decentralized to the state level

Integrated malaria programme since 1981 (national) and 1986 (Sabah and Sarawak)b

+ Funding and decision making mainly originated from the central level, while the states were also held accountable for the impact on the ground

MUS

Decentralized

Semi-vertical malaria programme structure, malaria programme was integrated into the public health system in 1968

++ Semi-vertical malaria programme translated to most accountability resting with the malaria division of the Communicable Diseases Control Unit at the national level

NAM

Decentralized

Integrated malaria programme structure since inception in 1991b

++ National level appeared to be most accountable

PHL

Decentralized starting in 1958, implemented thoroughly in 1990s

Integrated malaria programme with health services since 1982, however some vertical elements (regional and sub-regional malaria specific positions) remain

++ Local level malaria programmes were relatively autonomous and accountable for the progress of malaria control, however there were nationally-funded personnel in each province to supervise and monitor activities but with no decision-making authority

LKA

Decentralized since 1989

Malaria is integrated with other vector borne diseases and with curative services through health system structure

++ National office appeared to be mainly accountable, however district malaria officers were responsible for malaria implementation and impact in their districts and reported to both the national programme and regional director of health services

TUR

Centralized system, Ministry of Health responsible for health care and social welfare activities, supervises all medical and health care personnel in the public sector, Education and health services are provided by the central government

A vertical malaria network was developed since 1920s with three levels:

1. National Malaria Commission (national level);

2. Province/district level with laboratory and headed by a physician with staffing of other malaria control personnel;

3. Peripheral level (subsections or “circles” of 10–15 villages), with personnel for vector control

++ The Directorate of Malaria Control was accountable for malaria strategy and achievements

TKM

Not clarified in case study, but assumed to be centralized

Most likely semi-vertical, The Sanitary Epidemiological Service (SES) responsible for communicable disease control including anti-malarial interventions, national, provincial and district level SES offices, SES considered specialized in malaria control, and works with the general primary health care services for malaria interventions

++ National-level SES appeared to be accountable for the impact of the malaria programme

  1. BTN Bhutan, CPV Cabo Verde, MYS Malaysia, MUS Mauritius, NAM Namibia, PHL Philippines, LKA Sri Lanka, TUR Turkey, TKM Turkmenistan
  2. 0 not clear, + moderately clear, ++ clear
  3. aThe measure of the clarity of accountability within each malaria programme was an assessment based on the information in the case-studies on the responsibility for progress or impact, decision making, and funding of each malaria programme
  4. bNo further information provided in case-study report as to the type of integration of the malaria programme