A retrospective analysis of the change in anti-malarial treatment policy: Peru.
BACKGROUND
National malaria control programmes must deal with the complex process of changing national malaria treatment guidelines, often without guidance on the process of change. Selecting a replacement drug is only one issue in this process. There is a paucity of literature describing successful malaria treatment policy changes to help guide control programs through this process.


OBJECTIVE
To understand the wider context in which national malaria treatment guidelines were formulated in a specific country (Peru).


METHODS
Using qualitative methods (individual and focus group interviews, stakeholder analysis and a review of documents), a retrospective analysis of the process of change in Peru's anti-malarial treatment policy from the early 1990's to 2003 was completed.


RESULTS
The decision to change Peru's policies resulted from increasing levels of anti-malarial drug resistance, as well as complaints from providers that the drugs were no longer working. The context of the change occurred in a time in which Peru was changing national governments, which created extreme challenges in moving the change process forward. Peru utilized a number of key strategies successfully to ensure that policy change would occur. This included a) having the process directed by a group who shared a common interest in malaria and who had long-established social and professional networks among themselves, b) engaging in collaborative teamwork among nationals and between nationals and international collaborators, c) respect for and inclusion of district-level staff in all phases of the process, d) reliance on high levels of technical and scientific knowledge, e) use of standardized protocols to collect data, and f) transparency.


CONCLUSIONS
Although not perfectly or fully implemented by 2003, the change in malaria treatment policy in Peru occurred very quickly, as compared to other countries. They identified a problem, collected the data necessary to justify the change, utilized political will to their favor, approved the policy, and moved to improve malaria control in their country. As such, they offer an excellent example for other countries as they contemplate or embark on policy changes.
Williams
Holly Ann
HA
Malaria Branch, Centers for Disease Control and Prevention (CDC), Mail Stop F-60, 4770 Buford Hwy NE, Atlanta, Georgia 30341, USA. hbw2@cdc.gov
Vincent-Mark
Arlene
A
Herrera
Yenni
Y
Chang
O Jaime
OJ
D000962:Antimalarials / Q000627:therapeutic use*; D003299:Cooperative Behavior; D003625:Data Collection; D003657:Decision Making; D004351:Drug Resistance; D006282:Health Personnel / Q000191:economics / Q000193:education; D006291:Health Policy / Q000266:history*; D006280:Health Workforce; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000517:prevention & control; D010568:Peru; D036301:Qualitative Research; D012189:Retrospective Studies
D000962:Antimalarials