We used a participatory, action-oriented approach with malaria teams in Swaziland and Zimbabwe to improve service delivery, raise team performance, and develop leadership capacity. We implemented this approach at the national level in Swaziland and district level in Zimbabwe.
At the beginning of the malaria season, we conducted workshops to help teams work more effectively together through structured exercises to facilitate communication and see varying perspectives. Through these exercises the group identified, analyzed, and prioritized operational challenges. A cross-disciplinary Task Team, a subset of the group, met at least three times to take these challenges forward until the next workshop at the end of the season. Expert coaching and facilitation were provided to each Task Team to develop a work plan with associated metrics and individuals to implement improvements to the collective management challenges. The assignment of specific individuals and development of metrics ensured accountability to achieve results. The Task Team met regularly throughout the season to progress the improvements, and the wider whole-system group reconvened to evaluate and define new priorities at the end of the season.
In both countries, there were improvements in the reporting of malaria cases at the health facility level. In Swaziland, communication between units improved, and collaboration with CBOs increased. In Zimbabwe, there were decreases in drug stockouts and improvements in the timeliness of case investigation rates.
Improving the effectiveness of malaria programs through a participatory, action-oriented approach can result in significant operational improvements over one malaria season. Additional research needs to be conducted to see if this approach is cost-effective and if these changes can be sustained over time, scaled up to the provincial level and down to clinic level, and imbedded into the program with the training of malaria staff who can serve as management improvement coaches.