title: Challenges in and lessons learned during the implementation of the 1-3-7 malaria surveillance and response strategy in China: a qualitative study.
abstract: BACKGROUND
  China has made great progress in malaria control over the last century and now aims to eliminate malaria by 2020. In 2012, the country launched its 1-3-7 surveillance and response strategy for malaria elimination. The strategy involves to case reporting within 1 day, case investigation within 3 days, and focus investigation and public health actions within 7 days. The aim of this study was to evaluate the challenges in and lessons learned during the implementation of the 1-3-7 strategy in China so far.
  
  
  METHODS
  This qualitative study was conducted in two provinces in China: Gansu province (northwestern China) and Jiangsu province (southeastern China) in 2014. Key informant interviews (n = 6) and in-depth interviews (n = 36) about the implementation aspects of the 1-3-7 strategy were conducted with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels.
  
  
  RESULTS
  Broad themes related to the challenges in and lessons learned during the implementation of the 1-3-7 strategy were identified according to: case reporting within 1 day, case investigation within 3 days, focus investigation within 7 days, and the overall strategy. The major challenges outlined were related to respecting the timeline of surveillance procedures, the absence of or difficulties in following guidelines on conducting focus investigations, diagnostics, and the increasing number of returning migrant workers from malaria-endemic countries. Important lessons learned revolve around the importance of continuous capacity building, supervision and motivation, quality control, information technology support, applied research, governmental commitment, and intersectoral collaboration.
  
  
  CONCLUSIONS
  Surveillance is a key intervention in malaria elimination programs. The Chinese 1-3-7 strategy has already proven to be successful but still needs to be improved. In particular, dealing appropriately with imported malaria cases through the screening of migrant workers from malaria-endemic countries is essential for achieving and sustaining malaria elimination in China. China has perfect preconditions for successful malaria elimination provided political commitment and financial investment are guaranteed. The 1-3-7 strategy may also be considered as a model for other countries.
authors.affiliation: Department of Preventive Medicine, Medical College of Yangzhou University, Yangzhou University, 225001, Yangzhou, China. Guangyu.Lu@stud.uni-heidelberg.de.|Institute of Public Health, Medical School, The Ruprecht-Karls-Universität Heidelberg, INF 324, 69120, Heidelberg, Germany. Guangyu.Lu@stud.uni-heidelberg.de.
authors.forename: Guangyu
authors.identifier: http://orcid.org/0000-0003-2568-7091
authors.initials: G
authors.lastname: Lu
authors.affiliation: Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.
authors.forename: Yaobao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Institute of Public Health, Medical School, The Ruprecht-Karls-Universität Heidelberg, INF 324, 69120, Heidelberg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Beiersmann
authors.affiliation: Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China. caojuncn@hotmail.com.|Public Health Research Center, Jiangnan University, Wuxi, China. caojuncn@hotmail.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Cao
authors.affiliation: Institute of Public Health, Medical School, The Ruprecht-Karls-Universität Heidelberg, INF 324, 69120, Heidelberg, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
mesh_terms: D002681:China; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control*; D011159:Population Surveillance / Q000379:methods*
keywords: 1-3-7 surveillance and response strategy; China; Malaria; Qualitative research