Cross-Country Synthesis: Malaria Subnational Tailoring

Malaria is preventable, treatable, and curable, but it remains a devastating disease that puts nearly half of the world's population at risk each year. A major challenge in reducing the global malaria burden lies in the highly heterogeneous nature of malaria transmission: it varies between and within countries depending on climate, vector ecology, health system capacity, socioeconomic conditions, and other contextual factors. “One-size-fits-all” national strategies often fail to reach the most at-risk populations, deploy interventions where they may not have the greatest impact, or misallocate limited resources.

In 2018, the World Health Organization (WHO) and the Roll Back Malaria Partnership launched the High Burden to High Impact (HBHI) initiative, which supports the use of local data in countries with the highest malaria burden and customizes the deployment of interventions at regional, district, or municipal levels. This approach, known as subnational tailoring (SNT), has improved the efficiency and impact of malaria control strategies across low- and middle-income countries worldwide.,

The Exemplars in Malaria SNT study focused on four countries with a high burden of malaria (Burkina Faso, Mozambique, Nigeria, and Tanzania) and one country nearing malaria elimination (Lao PDR) that were early and successful adopters of malaria SNT relative to their peers (Figure 1). The study identified promising practices for effective SNT implementation across the five Exemplar countries, along with opportunities for improvement and key lessons for other high-burden and near-elimination settings worldwide.

Figure 1: Exemplars in malaria subnational tailoring study countries

Subnational tailoring (SNT) enables countries to prioritize malaria interventions for specific regions or localities. A conceptual framework developed in partnership with the Harvard T.H. Chan School of Public Health and Applied Health Analytics for Delivery and Innovation describes the SNT process as a continuous cycle:

1. Generating the evidence, in which stakeholders gather data at the regional, district, and municipal levels;
2. Synthesizing the evidence, in which policymakers analyze that data and translate it into recommendations for localized interventions;
3. Acting on the evidence, or delivering interventions and measuring their impact.

For each step in this process, the Exemplars in Malaria SNT study identified promising practices adopted by most Exemplar countries that enabled the effective development, consolidation, and implementation of SNT evidence (Figure 2).

Figure 2: Malaria SNT promising practices

The following sections outline the different phases of SNT, with each section highlighting promising practices observed in at least three of the five Exemplar countries. To learn more, click through the sections on this page to see selected countries that exemplify each practice.