Malaria Elimination Programme Management: A Prospective UoA 19 Impact Case Study, REF UWE/BAM Maximizing Your Impact Workshop, 27 th April 2016 Peter Case Professor of Organization Studies

Presentation Outline Background context Underpinning research Tackling the malaria: Bill & Melinda Gates Foundation - Malaria Elimination Initiative Preparing Vietnam for elimination: Applied Organization Development & Participatory Action Research for improved operations Impacts to date & on-going/future work

Personal Background FBL professor of organization studies Founding Director, Bristol Centre for Leadership & Organizational Ethics (UWE) – now Bristol Leadership Centre Experience/academic interests & expertise: -Early career (ICL/NHS) -Leadership development programmes (Exeter CLS) -Organization Development & change initiatives -Research and publication: organization theory and philosophy, leadership studies, international development -Applied research: 3 rural development projects in Laos; BMGF Malaria Elimination Initiative.

Malaria elimination How I got involved

Underpinning Research Global Health Group, UCSF, Background paper: ‘Program Management Issues in Implementation of Elimination Strategies’ Gosling J, Case P, Tulloch J, Chandramohan D, et al. (2015) Effective program management: A cornerstone of malaria elimination. American Journal of Tropical Medicine & Hygiene 93(1):

Summary of Research Findings What Works Robust local health system Leadership Incentives Expert epidemiological oversight & surveillance Regional collaborations Formalized organizational learning structure What Does Not Work Systemic roadblocks –very weak health systems, conservativism, lack of political commitment Non-specialists in management positions & lack of continuity External donor constraints Operational constraints –E.g., Cultural resistance, absence of incentives, inadequate training, incomplete/inaccurate /misuse of information

Eliminating Malaria Malaria elimination defined by the WHO as: ‘.. zero locally acquired malaria cases for at least three consecutive years’ (WHO, 2013: 45). Endemicity, morbidity & mortality have all reduced significantly in the past two decades (e.g., Vietnam: from 60,000+ deaths in 2000 to c.6 in 2015). However, last year: 214 million malaria cases globally; estimated 438,000 related deaths. Elimination entails ‘disruption of disease transmission’. Basic epidemiology: disease carried by mosquitoes, humans and other mammals – symbiotic relationship between parasite and mosquito/human hosts. Two main ‘vectors’: mostquitos and humans. 5 types of parasite but Plasmodium Falciparum most common and most dangerous. Technologies to control/disrupt transmission targeted at these vectors (detection/surveillance, prevention/treatment, mosquito control).

Disrupting Transmission by Targeting ‘Hot Pops’ in Elimination Zones Hot pops high risk groups

Surveillance for Elimination Surveillance as an intervention Shift in geographic scale of surveillance Use of GIS/Spatial Decision Support Systems Real-time reporting/situation rooms Targeted interventions

Surveillance Systems for Elimination

Preparing Vietnam for Malaria Elimination Contracted by the BMGF MEI research centre to support the University of California San Francisco medical team spearheading elimination efforts in Vietnam (Jan Dec 2015). Assisted with: Project management Strategic Negotiations with WHO, Ministry of Health, Vietnamese People’s Army, National Institute of Malaria Parasitology and Epidemiology Fieldwork interventions: Participatory Action Research to improve operations and service delivery in Phu Yen and Quang Tri Provinces.

Project Partners Global Health Group, Malaria Elimination Initiative (MEI), UCF Bill & Melinda Gates Foundation John Hopkins University Pittsburg Supercomputing Centre University of Queensland University of the West of England

Impacts to Date from MEI Research & Vietnam Project Adoption of MEI ’Program Management’ Report by Clinton Health Access Initiative (Greater Mekong Sub-region) as a staff training manual. Harmonization of BMGF strategic aims with those of other key stakeholders in Vietnam (e.g., WHO Vietnam, MoH, NIMPE). Identification of the role which Malaria Elimination Task Forces can play in eliminating malaria. Facilitation of the practical testing of Task Force operational units using Participatory Action Research intervention methods. Improvements to operational management processes (structured activity planning, structured reporting, performance management, etc.)

On-Going Work with BMGF/MEI Recently visited southern Africa to scope a new project to run leadership & Organization Development workshops for National Malaria Control Programs (NMCPs) and CHAI in Swaziland and Zimbabwe. Using PAR methods to improve service delivery. Project approved ( ). Malaria pre-season workshops will be run in late August. BMGF highly supportive of this pilot initiative. Top level support from NMCPs. On-going consultancy in the Greater Mekong Sub-region.

Thank you. Comments & Questions Welcome Malaria Elimination Programme Management: A Prospective UoA 19 Impact Case Study, REF 2020+