title: Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors' involvement.
abstract: In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change.
authors.affiliation: GlobalHealth@UNSW and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. joaosmartins@hotmail.com
authors.forename: João S
authors.initials: JS
authors.lastname: Martins
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Zwi
authors.forename: Karen
authors.initials: K
authors.lastname: Hobday
authors.forename: Fernando
authors.initials: F
authors.lastname: Bonaparte
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kelly
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002985:Clinical Protocols; D003299:Cooperative Behavior; D004338:Drug Combinations; D057915:Drug Substitution; D004983:Ethanolamines / Q000627:therapeutic use*; D005449:Fluorenes / Q000627:therapeutic use*; D006288:Health Planning Organizations; D006291:Health Policy / Q000639:trends; D006801:Humans; D007373:Interinstitutional Relations; D016778:Malaria, Falciparum / Q000188:drug therapy*; D011050:Policy Making; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D013997:Time Factors; D049648:Timor-Leste
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine