title: Institutional evolution of a community-based programme for malaria control through larval source management in Dar es Salaam, United Republic of Tanzania.
abstract: BACKGROUND
  Community-based service delivery is vital to the effectiveness, affordability and sustainability of vector control generally, and to labour-intensive larval source management (LSM) programmes in particular.
  
  
  METHODS
  The institutional evolution of a city-level, community-based LSM programme over 14 years in urban Dar es Salaam, Tanzania, illustrates how operational research projects can contribute to public health governance and to the establishment of sustainable service delivery programmes. Implementation, management and governance of this LSM programme is framed within a nested set of spatially-defined relationships between mosquitoes, residents, government and research institutions that build upward from neighbourhood to city and national scales.
  
  
  RESULTS
  The clear hierarchical structure associated with vertical, centralized management of decentralized, community-based service delivery, as well as increasingly clear differentiation of partner roles and responsibilities across several spatial scales, contributed to the evolution and subsequent growth of the programme.
  
  
  CONCLUSIONS
  The UMCP was based on the principle of an integrated operational research project that evolved over time as the City Council gradually took more responsibility for management. The central role of Dar es Salaam's City Council in coordinating LSM implementation enabled that flexibility; the institutionalization of management and planning in local administrative structures enhanced community-mobilization and funding possibilities at national and international levels. Ultimately, the high degree of program ownership by the City Council and three municipalities, coupled with catalytic donor funding and technical support from expert overseas partners have enabled establishment of a sustainable, internally-funded programme implemented by the National Ministry of Health and Social Welfare and supported by national research and training institutes.
authors: Ifakara Health Institute, Environmental Health and Ecological Sciences Thematic Group, Kiko Avenue, Mikocheni, PO Box 78373, Dar es Salaam, United Republic of Tanzania. pchaki@ihi.or.tz.
authors: Prosper P
authors: PP
authors: Chaki
authors: Khadija
authors: K
authors: Kannady
authors: Deo
authors: D
authors: Mtasiwa
authors: Marcel
authors: M
authors: Tanner
authors: Hassan
authors: H
authors: Mshinda
authors: Ann H
authors: AH
authors: Kelly
authors: Gerry F
authors: GF
authors: Killeen
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods* / Q000458:organization & administration*; D013636:Tanzania; D014505:Urban Population