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Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries

Authors
  • Parkhurst, Justin1
  • Ghilardi, Ludovica2
  • Webster, Jayne2
  • Snow, Robert W3
  • Lynch, Caroline A2
  • 1 Department of Health Policy, London School of Economics and Political Science, UK , (United Kingdom)
  • 2 London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK , (United Kingdom)
  • 3 Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya , (Kenya)
Type
Published Article
Journal
Health Policy and Planning
Publisher
Oxford University Press
Publication Date
Dec 14, 2020
Volume
36
Issue
1
Pages
35–44
Identifiers
DOI: 10.1093/heapol/czaa166
PMID: 33319225
PMCID: PMC7938496
Source
PubMed Central
Keywords
License
Unknown

Abstract

This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.

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