Evidence uptake is only part of the process: Stakeholders' insights on WHO treatment guideline recommendation processes for radical cure of P. vivax malaria

PLOS Glob Public Health. 2024 Mar 14;4(3):e0002990. doi: 10.1371/journal.pgph.0002990. eCollection 2024.

Abstract

Health policy processes should be evidence-informed, transparent and timely, but these processes are often unclear to stakeholders outside the immediate policymaking environment. We spoke to 36 international malaria stakeholders to gain insights on the processes involved in the World Health Organization's Global Malaria Programme's recommendations for their treatment guidelines of P. vivax malaria. Four key themes which drew on the 3i policy framework and Shiffman's four factors that influence global and national policymaking were identified to understand these processes. Triggers for policy change and change prioritisation, evidence types that inform policy, effects of funding on decision-making processes, and transparency and communication of these processes to external stakeholders. Results indicate that more clarity is needed on what triggers global malaria policy change processes, a clearer justification of evidence types used to inform policymaking, better understanding of the impact of the WHO's funding model on policymaking and further transparency and improved communication of these processes to external stakeholders is also needed. We suggest that global malaria policymaking could be improved by using the following strategies: ensuring that identified triggers actually initiate the policy change process, expediting decision-making timelines by developing a priority framework for assessing new evidence, adopting suitable frameworks to assess contextual evidence, and increasing the transparency of the role of non-state funders in policy decision-making processes and when publishing new recommendations.

Grants and funding

This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [INV-010504]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Varunika Ruwanpura was funded by an Australian Government Research Training Program stipend from Charles Darwin University from 2019 to 2022 and received a travel grant from the Australian Centre of Research Excellence in Malaria (APP 1134989). Kamala Thriemer is funded by a CSL Centenary Fellowship and Ric N Price is funded by an Australian National Health and Medical Research (NHMRC) Leadership Investigator Grant (2008501). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.