Addressing organisational challenges to improve malaria health care in southern Africa

Impact Area: Global Health, Disease Prevention

Institution: Bristol Business School, University of the West of England

Leading Academic: Professor Peter Case

Organization Development for Malaria Elimination staff and trainees. From left to right: Dr Greyling Viljoen, Dr Gladwin Muchena, Professor Peter Case, Dr Macdonald Hove, Mr Munashe Madinga, Ms Nomaqhawe Mpala, Prof. Jonathan Gosling, Prof. Peliwe Mnguni, Dr Rudo Chikodzore, Mr Notho Dube.



Work conducted by a Bristol Business School Professor on organisational systems in malaria zones has had a significant impact on international efforts to eradicate the disease.  Backed by the Bill and Melinda Gates Foundation-funded Malaria Elimination Initiative, Professor Peter Case’s work has introduced a new approach to tackling malaria in Zimbabwe and eSwatini.

Every year some half a million people die from the disease, which still exists in nearly 100 countries. Humans bitten by infected mosquitoes carrying the parasite can experience high fevers, chills, and other severe symptoms.

Although many NGOs distribute treated mosquito nets, or supply anti-malaria tablets to high-risk communities, human and organisational factors are often overlooked, says the academic.

Past examples of challenges these workers have experienced include instances when villagers who are issued with mosquito nets are later seen using them for fishing. In another African village, witnesses have noted that people who develop malaria symptoms sometimes seek non-medical care from traditional healers rather than go to a clinic.

“A vaccine or technology used as a solution is often seen as a silver bullet and is vital. But I believe this makes up only five percent of what can be done – the remaining 95% comes down to dealing with the flaws, difficulties, idiosyncrasies and foibles of human organisational systems,” he says.


Benefits and Impact

Professor Case’s work, in partnership with the University of California, San Francisco (UCSF), provides methods to identify, analyse, and resolve context-specific challenges. Through a series of workshops taking place in the country where malaria poses a threat, members of staff (from the most junior front-line staff to the most senior medics and administrators) are able to meet in the same space and communicate the challenges they face when tackling malaria.

Together, they can then generate collective solutions and trace necessary changes that need to be made within the delivery system to improve prevention and treatment.

“While all the workshop participants play a crucial role in the process, hands-on expertise lies at the front line, because these are the people who see others with the disease day in day out, or who go in to spray homesteads,” says Professor Case.

This exercise of generating a list of shared challenges leads to a practical work plan with a dedicated group of people who take responsibility for implementing solutions. It has helped instil self-confidence and assertiveness within individuals who work on the front line, helping staff to realise that they can rely on themselves and colleagues to problem solve.

Professor Case’s work has had significant impact in southern Africa. Implementing this methodology across eSwatini has led to improvements in the reporting of malaria cases by health facilities and increased collaboration between the malaria programme, schools, and community organisations. It has also led to improved communication between leaders within the National Malaria Control Programme (NMCP).

In Zimbabwe’s Matabeleland South province, Case’s system of structured organisational development led to notable improvements over the 2016-17 malaria season, including improvement in the availability and use of malaria registers by health facilities, a decrease in stock-outs of key malaria treatment drugs, and an increase in malaria case investigation rate within three days:

Malaria Registers: 83% to 93% improvement in usage over the season.

Atemisinin Combined Therapy (main anti-malaria drug): stockout reduced from 22% to 6%.

Primaquine (anti-malarial drug): stockout reduced from 3 health facilities in Matabeleland South, to 1 health facility.

Malaria Case Investigation rates: 55% - 65% improvement over the season.

The project is now also operational in the Matabeleland North and Midlands provinces, over half of the country in geographical terms. Although the challenges being addressed are region specific, impacts of a similar order for the 2017-18 are expected in each of the provinces.

To ensure the project remains sustainable, Bristol Business School (BBS) has begun training six senior medical and administrative staff from Matabeleland South, via a PG Cert in Professional Practice in Change Leadership, which they are undertaking through distance learning.

As part of their training, these initial recruits have been helping the BBS research team facilitate workshops and follow-up meetings in Midlands and Matabeleland North in the 2017-18 season. The hope is that they will work on similar process improvement initiatives in other malaria-prone countries in southern Africa, beginning in 2018-19 with Namibia.