Subnational tailoring of malaria interventions for strategic planning and prioritization: experience and perspectives of five malaria programs

In the context of high malaria burden and insufficient resources, several national malaria programs (NMPs) used subnational tailoring (SNT) as a tool for evidence-informed decision-making on their national malaria strategic plans and funding requests. The SNT process included the formation of an SNT team, determination of criteria for targeting interventions, data assembly and review, stratification, application of targeting criteria to determine preliminary plans, mathematical modeling, finalization of intervention plans, and monitoring and evaluation of the eventual implemented plan, all under the leadership of the NMP. Analysis steps of SNT were supported by the World Health Organization (WHO) and other partners. As SNT was a new approach, this study used semi-structured interviews to understand the perspectives and experiences of personnel from five NMPs (Burkina Faso, Ghana, Guinea, Nigeria, and Togo) that undertook SNT between 2019 and 2023. Participants reported that SNT outputs were used to inform national strategic plans and prioritized plans, that the process incentivized improvements in data collection and data quality, and that NMPs were strongly motivated to grow their capacity to conduct more steps of the SNT analysis process internally. Major challenges included the lack of resources available to implement the full strategic plans as well as challenges with data quality and alignment of stakeholders. Participants reported a moderate to strong sense of ownership over the process and were eager to extend, adapt, and reuse the SNT process in the future. Among countries supported by WHO, SNT was well-accepted and allowed NMPs to successfully use evidence to inform their decision-making, advocate for themselves, and mobilize resources.