Work conducted by a Bristol Business School Professor on organisational systems in malaria zones has had a significant impact on international efforts to eradicate the disease. Backed by the Bill and Melinda Gates Foundation-funded Malaria Elimination Initiative, Professor Peter Case’s work has introduced a new approach to tackling malaria in Zimbabwe and Swaziland.
Every year some half a million people die from the disease, which still exists in nearly 100 countries. Humans bitten by infected mosquitoes carrying the parasite can experience high fevers, chills, and other severe symptoms.
Although many NGOs distribute treated mosquito nets, or supply anti-malaria tablets to high-risk communities, human and organisational factors are often overlooked, says the academic.
“A vaccine or technology used as a solution is often seen as a silver bullet and is vital. But I believe this makes up only five percent of what can be done – the remaining 95% comes down to dealing with the flaws, difficulties, idiosyncrasies and foibles of human organisational systems,” he says.
Professor Case’s work, in partnership with the University of California, San Francisco (UCSF), provides methods to identify, analyse, and resolve context-specific challenges. Through a series of workshops taking place in the country where malaria poses a threat, members of staff (from the most junior front-line staff to the most senior medics and administrators) are able to meet in the same space and communicate the challenges they face when tackling malaria.
Together, they can then generate collective solutions and trace necessary changes that need to be made within the delivery system to improve prevention and treatment.
“While all the workshop participants play a crucial role in the process, hands-on expertise lies at the front line, because these are the people who see others with the disease day in day out, or who go in to spray homesteads,” says Professor Case.
Past examples of challenges these workers have experienced include instances when villagers who are issued with mosquito nets are later seen using them for fishing. In another African village, witnesses have noted that people who develop malaria symptoms sometimes seek non-medical care from traditional healers rather than go to a clinic.
This exercise of generating a list of shared challenges leads to a practical work plan with a dedicated group of people who take responsibility for implementing solutions. It has helped instil self-confidence and assertiveness within individuals who work on the front line, helping staff to realise that they can rely on themselves and colleagues to problem solve.
Professor Case’s work has had significant impact in southern Africa. Implementing this methodology across Swaziland has led to improvement in the reporting of malaria cases by health facilities and increased collaboration between the malaria program, schools, and community organisations. It has also led to improved communication between leaders within the National Malaria Control Programme (NMCP).
In Zimbabwe’s Matabeleland South, Case’s system of structured organizational development has led to improvement in the availability and use of malaria registers by health facilities, a decrease in stock-outs of key malaria treatment drugs, and an increase in malaria case investigation rate within three days.
To ensure the project remains sustainable, Bristol Business School has begun training six medical staff at all levels of seniority in Zimbabwe via a PG Cert in Leadership and Professional Practice, which they are undertaking through distance learning.
These initial trainees will be assisting with similar process improvement initiatives in other malaria-prone countries in southern Africa, beginning in 2018 with Namibia.