Challenges and opportunities associated with the introduction of next-generation long-lasting insecticidal nets for malaria control: a case study from Burkina Faso

Kemi Tesfazghi, Adama Traore, Hilary Ranson, Sagnon N’Fale, Jenny Hill, Eve Worrall

Reductions in malaria incidence in Africa can largely be attributed to increases in malaria vector control activities; predominately the use of long-lasting insecticidal nets (LLINs). With insecticide resistance affecting an increasing number of malaria-endemic countries and threatening the effectiveness of conventional LLINs, there is an increasing urgency to implement alternative tools that control these resistant populations. The aim of this study was to identify potential challenges and opportunities for accelerating access to next-generation LLINs in Burkina Faso, a country with areas of high levels of insecticide resistance. An analytical framework was used to guide the selection of interviewees, data collection and analysis. Semi-structured interviews were carried out with key informants in April 2014 in Burkina Faso. Interviews were conducted in French and English, audio recorded, transcribed and entered into NVivo 10 for data management and analysis. Data were coded according to the framework themes and then analysed to provide a description of the key points and explain patterns in the data. Interviewees reported that the policy architecture in Burkina Faso is characterised by a strong framework of actors that contribute to policymaking and strong national research capacity which indirectly contributes to national policy change via collaboration with internationally led research. Financing significantly impacts the potential adoption, availability and affordability of next-generation LLINs. This confers significant power on international donors that fund vector control. National decisions around which LLINs to procure were restricted to quantity and delivery dates; the potential to tackle insecticide resistance was not part of the decision-making process. Furthermore, at the time of the study, there was no World Health Organization (WHO) guidance on where and when next-generation LLINs might positively impact on malaria transmission, severely limiting their adoption, availability and affordability. This study shows that access to next-generation LLINs was severely compromised by the lack of global guidance. In a country like Burkina Faso where WHO recommendations are relatively quickly adopted, a clear WHO recommendation and adequate financing will be key to accelerate access to next-generation LLINs.