title: Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania.
abstract: BACKGROUND
  Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST).
  
  
  METHODS
  Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate.
  
  
  RESULTS
  Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides.
  
  
  CONCLUSIONS
  Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.
authors.affiliation: Centre for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria, 0001, South Africa. cmutero@icipe.org.
authors.forename: Clifford M
authors.initials: CM
authors.lastname: Mutero
authors.forename: Randall A
authors.initials: RA
authors.lastname: Kramer
authors.forename: Christopher
authors.initials: C
authors.lastname: Paul
authors.forename: Adriane
authors.initials: A
authors.lastname: Lesser
authors.forename: Marie Lynn
authors.initials: ML
authors.lastname: Miranda
authors.forename: Leonard E G
authors.initials: LE
authors.lastname: Mboera
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kiptui
authors.forename: Narcis
authors.initials: N
authors.lastname: Kabatereine
authors.forename: Birkinesh
authors.initials: B
authors.lastname: Ameneshewa
mesh_terms: D000351:Africa, Eastern; D000962:Antimalarials / Q000627:therapeutic use; D003661:Decision Support Techniques; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D011050:Policy Making
chemical_list: D000962:Antimalarials
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