Facilitators, barriers and acceptability of malaria reactive surveillance and response strategies in Vietnam: a mixed-methods study

Abstract

Introduction Vietnam has achieved significant reductions in its malaria caseload over the past decades and is progressing towards malaria elimination. To achieve malaria elimination, the Vietnam Ministry of Health issued Guidelines for Malaria Surveillance and Prevention, a surveillance guide that describes malaria reactive surveillance and response (RASR) strategies—its implementation—is yet to be evaluated. Here, the facilitators, barriers and acceptability of the implementation of RASR strategies in Vietnam are explored and discussed thoroughly to provide recommendations for improvement of RASR strategies.Methods A mixed-methods study was conducted in Binh Thuan and Phu Yen Provinces in Vietnam from November 2021 to April 2022 including quantitative surveys with health stakeholders and staff (n=36) and frontline health service providers (n=38), qualitative focus group discussions with frontline health service providers and mobile migrant populations (n=70) and semistructured in-depth interview with health stakeholders and staff (n=28). Quantitative and qualitative data were analysed descriptively and thematically.Results Vietnam’s health system supports RASR strategies, and the RASR implementation data are well captured in the electronic communicable disease surveillance system of the Ministry of Health. Overall, RASR strategies are acceptable to both stakeholders and community members. However, successful implementation of RASR strategies is hindered by declining community interest in malaria elimination programme and limitations of infrastructure, budget, human resources, and terrain difficulties.Conclusions Overall health system support and policy commitment are key to successful implementation of RASR strategies and therefore for achieving malaria elimination. Despite high-performance and well-accepted RASR strategies, more financial and human resource investments are warranted to investigate and respond to all malaria foci in time. Village health workers could be used effectively to engage community members and mobile migrant populations in RASR activities.