Making malaria prevention work

Malaria remains one of the world’s deadliest infectious diseases, but developing effective ways to prevent it is only part of the challenge. Vaccines, anti-malarial medicines and insecticide-treated bed nets can all save lives. The question is: how do you make sure they reach the people who need them?

For more than a decade, UWE Bristol’s Professor Peter Case has been working with international partners to tackle challenges like this from a different angle. His research focuses not on developing new malaria treatments, but on strengthening the health systems that deliver them.

At the heart of this work is LEAD: the Leadership and Engagement for improved Accountability and Delivery of Services Framework. Developed by Peter Case, Professor Jonathan Gosling (Visiting Professor at the Bristol Leadership and Change Centre) and international research collaborators, LEAD is an organisational development and quality assurance methodology designed to improve how health programmes are managed and delivered.

Now, through a major international malaria study, the approach is being put to work in Cameroon and Côte d’Ivoire, with the potential to improve malaria prevention for thousands of children under five.

The word Malaria on a green background with blurred text and composition of pills, syringe and stethoscope.

"The approach brings together the people who really understand the whole system and gives them the opportunity to solve the problem together."

Professor Peter Case, Professor of Organization Studies

Professor Peter Case Professor of Organization Studies

Putting the system in the room

Malaria prevention is not simply a question of having the right treatment available. Health services need to reach communities, families need to access them and interventions need to work within local systems and circumstances.

Peter’s research asks a deceptively simple question: “What's stopping an effective health intervention from reaching the people who need it?”

The answer can lie in dozens of interconnected barriers. Health services may struggle with logistics, communities may face practical obstacles to accessing care, different parts of the health system may not communicate effectively and solutions designed at a national level may not reflect realities on the ground.

LEAD is designed to uncover these barriers by, in the first instance, replicating the whole system in one room.

Rather than imposing solutions from outside, it brings together the people involved in delivering and accessing a service, from health professionals and managers to community members. Together, they identify where things are going wrong, understand why and develop solutions that are practical, locally relevant and sustainable.

For example, Peter highlights a common challenge around childhood vaccination. Families may be good at taking children for their first vaccination, but attendance can fall dramatically during the second year. Instead of assuming why, the LEAD approach brings health professionals and communities together to understand the barriers and identify ways to overcome them.

From research to action

Peter’s latest malaria work is part of the three-year OPTiMIX study, led by the London School of Hygiene & Tropical Medicine and funded by UK Research and Innovation (UKRI) and the Medical Research Council.

The study is exploring how different malaria prevention interventions can be combined most effectively, including malaria vaccines, long-lasting insecticidal bed nets and malaria chemoprevention. It's taking place in selected high-transmission areas of Cameroon and Côte d’Ivoire.

LEAD is being used to tackle a crucial part of the challenge: how these interventions can actually be delivered effectively through local health systems.

The project is working across two districts in each country to identify sustainable, integrated approaches that improve access, coverage and delivery. Simulation modelling used in the successful funding application predicts that the overall project could reduce malaria incidence among infants in the intervention areas by around 43%.

For Peter and the wider LEAD team, the ambition isn't simply to test what works, but to understand how successful approaches can become embedded in health systems and continue beyond the life of an individual research project.

Building change that lasts

Sustainable change requires more than a short-term intervention. That is why the malaria project combines research with training.

UWE Bristol plans to deliver its Postgraduate Certificate in Professional Practice in Change Leadership* to health professionals involved in the work. Two small cohorts of health professionals in each country would be trained to apply the LEAD methodology, helping to build skills that can continue to improve health services beyond the OPTiMIX project. Collaborating on this work is UWE Bristol’s Dr Karine Mangion-Thornley, who's helping to design and deliver the training entirely in French.

The work is also creating a platform for LEAD to grow across Africa. Supported by seed funding from UWE Bristol, Peter and his collaborators established the LEAD Ubuntu Global Foundation (LUGF), a not-for-profit organisation registered in South Africa. LUGF provides a locally embedded platform through which LEAD can be applied to international health projects and attract future investment.

*Subject to approval

Changing systems to save lives

Peter’s work demonstrates that innovation in global health doesn't always mean inventing a new treatment. Sometimes, the breakthrough is finding a better way to make existing solutions work.

By bringing communities, health professionals and decision-makers together, strengthening local leadership and building the skills to sustain change, LEAD is helping to tackle one of the most difficult challenges in global health: turning effective interventions into effective services.

Its application across malaria, HIV/AIDS and other health challenges demonstrates the potential for the approach to significantly improve health systems. Through OPTiMIX, that approach is now being tested in the fight against malaria. If it succeeds, the impact could extend well beyond a single project or disease.