Barriers to the functionality and responsiveness of the malaria surveillance and data use system in Cameroon: a qualitative cross-sectional study
6 affiliations
- 1Clinton Health Access Initiative, HS Jean-Paul II Boulevard, Tsinga sous-Prefecture, P.O. Box 5241, Yaoundé, Cameroon
- 2Department of Public Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
- 3Clinton Health Access Initiative Inc, 383 Dorchester Avenue, Suite 400, Boston, MA 02127 USA
- 4National Malaria Control Program, Ministry of Public Health, Yaoundé, Cameroon
- 5Institute for Global Health, Santa Chiara Lab, University of Siena, Via Valdimontone 1, 53100 Siena, Italy
- 6The Department of Public Health and Health Professions, University of Florida, Florida, USA
Abstract
Background: Cameroon faces a considerable and rising burden of malaria. In 2024, the country recorded an estimated 7.6 million cases and 11,702 deaths, ranking among the 11 countries that collectively account for roughly 70% of the global malaria burden [1, 2]. The country has invested commendable efforts to address this high burden; however, overall progress toward key control indicators has stagnated and even slipped backward. One underlying reason for this stagnation is weaknesses in the country's surveillance systems, despite considerable efforts by key stakeholders to enhance system performance. This qualitative cross-sectional study focused on identifying barriers hindering the functionality and responsiveness of the malaria surveillance and data use system, to inform decision-making within Cameroon's malaria surveillance system.
Methods: This was a qualitative cross-sectional study conducted over five months (April-August 2023), with participants selected from six regions of Cameroon using a multi-stage purposive sampling method. Qualitative data were collected through key informant interviews (KIIs) and focus group discussions (FGDs) with stakeholders in the healthcare system, including Community Health Workers (CHWs), health facility staff, and district, regional, and central personnel. Data were analyzed thematically in NVivo version 12, following the Braun and Clarke six-phase framework for thematic analysis.
Results: A total of 69 interviews were conducted, comprising 51 KIIs (73.9%) and 18 FGDs (26.1%), involving 167 participants in total. Barriers included doctors' reluctance to document test results and treatments and their neglect of data collection; language and geographical constraints; the absence of a well-trained, dedicated data manager at the health facility level; a loss of community trust in healthcare professionals linked to the COVID-19 pandemic (a challenge reported by participants during the 2023 data-collection period); late delivery of near-expiration commodities; a lack of standardized guidelines for community health workers; and multiple technical faults on the District Health Information System 2 (DHIS2) mobile version.
Conclusion: The findings point to five priority areas for strengthening Cameroon's malaria surveillance system: (1) targeted workforce training and data-culture change among clinicians, (2) deployment of dedicated, trained data managers, (3) investment in digital health infrastructure (notably DHIS2 mobile performance), (4) development of standardized protocols for CHWs, and (5) community engagement to rebuild trust eroded during the pandemic. Strengthening these areas is essential to enhance data-driven decision-making and improve overall health system performance.
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BibTeX
@article{nkfusai2026barriers,
title = {{Barriers to the functionality and responsiveness of the malaria surveillance and data use system in Cameroon: a qualitative cross-sectional study}},
author = {Claude Ngwayu Nkfusai and Bernard Nsah and Norbert Lemonge and Magloire T. C. Kuetche and Herve Bella and Sirima Yaya and Sandra Mokom and Valerian Turbe and Julia Dunn and Flora Neh Njei and Moise Hugue Rene Abomabo and Jean Fosso and Marcellin Joel Ateba and Yauba Saidu},
journal = {Malaria Journal},
year = {2026},
month = aug,
doi = {10.1186/s12936-026-06091-9},
url = {https://doi.org/10.1186/s12936-026-06091-9},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Barriers to the functionality and responsiveness of the malaria surveillance and data use system in Cameroon: a qualitative cross-sectional study
AU - Claude Ngwayu Nkfusai
AU - Bernard Nsah
AU - Norbert Lemonge
AU - Magloire T. C. Kuetche
AU - Herve Bella
AU - Sirima Yaya
AU - Sandra Mokom
AU - Valerian Turbe
AU - Julia Dunn
AU - Flora Neh Njei
AU - Moise Hugue Rene Abomabo
AU - Jean Fosso
AU - Marcellin Joel Ateba
AU - Yauba Saidu
PY - 2026
DA - 2026/08/10
JO - Malaria Journal
DO - 10.1186/s12936-026-06091-9
UR - https://doi.org/10.1186/s12936-026-06091-9
AB - Background: Cameroon faces a considerable and rising burden of malaria. In 2024, the country recorded an estimated 7.6 million cases and 11,702 deaths, ranking among the 11 countries that collectively account for roughly 70% of the global malaria burden [1, 2]. The country has invested commendable efforts to address this high burden; however, overall progress toward key control indicators has stagnated and even slipped backward. One underlying reason for this stagnation is weaknesses in the country's surveillance systems, despite considerable efforts by key stakeholders to enhance system performance. This qualitative cross-sectional study focused on identifying barriers hindering the functionality and responsiveness of the malaria surveillance and data use system, to inform decision-making within Cameroon's malaria surveillance system. Methods: This was a qualitative cross-sectional study conducted over five months (April-August 2023), with participants selected from six regions of Cameroon using a multi-stage purposive sampling method. Qualitative data were collected through key informant interviews (KIIs) and focus group discussions (FGDs) with stakeholders in the healthcare system, including Community Health Workers (CHWs), health facility staff, and district, regional, and central personnel. Data were analyzed thematically in NVivo version 12, following the Braun and Clarke six-phase framework for thematic analysis. Results: A total of 69 interviews were conducted, comprising 51 KIIs (73.9%) and 18 FGDs (26.1%), involving 167 participants in total. Barriers included doctors' reluctance to document test results and treatments and their neglect of data collection; language and geographical constraints; the absence of a well-trained, dedicated data manager at the health facility level; a loss of community trust in healthcare professionals linked to the COVID-19 pandemic (a challenge reported by participants during the 2023 data-collection period); late delivery of near-expiration commodities; a lack of standardized guidelines for community health workers; and multiple technical faults on the District Health Information System 2 (DHIS2) mobile version. Conclusion: The findings point to five priority areas for strengthening Cameroon's malaria surveillance system: (1) targeted workforce training and data-culture change among clinicians, (2) deployment of dedicated, trained data managers, (3) investment in digital health infrastructure (notably DHIS2 mobile performance), (4) development of standardized protocols for CHWs, and (5) community engagement to rebuild trust eroded during the pandemic. Strengthening these areas is essential to enhance data-driven decision-making and improve overall health system performance.
SN - 1475-2875
ER -