Systems thinking approach in malaria control: a qualitative health system strengthening intervention

Sougat Ray and Rina Tilak

Background: Though 3.3 million deaths from malaria were prevented and lives of three million young children were saved but during the same time, malaria killed an estimated 6,27,000 people. Erratic use of insecticides have created a pool of resistant hygiene chemicals. Chloroquine and Artemisin have been used to combat malaria successfully but inappropriate use have resulted in drug resistant malaria. An integrated environmental management may be beneficial but success on such integration go beyond the biology and behavior of the individual human being and lot has largely remained unexplained. Systems thinking, is a tool that goes beyond this typical algorithm of input-output and is primarily a way of thinking in approaching constraints and in designing solutions. WHO has described six clearly defined interactive building blocks as a convenient device for exploring the health system and understanding the effects of interventions. Systems thinking is best understood by a causal loop diagram (CLD) model.
Methods: We included qualitative research and reviews dealing with programmatic constraints and solutions for malaria control.
Results: Costs involved and availability of insecticide treated mosquito nets, use of differential irrigation policy, effective use of information technology to report and predict malarial hotspots like insecticide and vector resistance and use of attractants were found to be measures which were deviant from the input-output model.
Conclusion: Understanding the environment in which the disease develops, the complex interrelationship of the variables and the feedback mechanism in which the system works, are required for the health decision makers to develop comprehensive, effective policies.

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