From Monotherapy to Combination Therapies (CT): A Retrospective Review of the Process of Policy Transfer Among Four Sub-Saharan Countries (Uganda, Zambia, Sudan and Malawi)

Policy change in a dynamic environment amidst an increasing infectious disease caseload remains a herculean task. While it is ideal to drive the process using evidence, emergencies in such situation makes policy transfer the best option. However, considering the difference in contextual health system issues which could affect the policy performance, how does a ‘wholesale’ transferred policy perform in a changing environment? Who do international actors drive the process of policy transfer? What is the motivation of national actors to adopt a policy without context-specific evidence? Using the Dolowitz and Marsh model of policy transfer, this paper reviews the processes of policy change of malaria regimen from monotherapies such as chloroquine to artemisinin combination therapies. It assesses the fundamental influencers of this transfer and the strategies employed in making this change. Also, the challenges encountered during this process are discussed within the spectrum of the model. Lessons from this transfer process are relevant in guiding future policy changes of infectious diseases in other resourceconstrained settings in Africa.

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From Monotherapy to Combination Therapies (CT): A Retrospective Review of the Process of Policy Transfer Among Four Sub-Saharan Countries (Uganda, Zambia, Sudan and Malawi)