World Health Organization · 1st edition, 2025 · 185 pages
Comprehensive technical manual for national malaria programmes to tailor intervention strategies to local epidemiology and contexts through data-driven planning.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- National malaria programmes, subnational malaria coordinators, implementing partners, technical experts supporting SNT, international and domestic funding agencies
- Evidence
- Expert consensus integrated with WHO normative guidance; consolidates methods from High Burden to High Impact approach and elimination country experiences
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This 185-page reference manual provides detailed technical guidance for national malaria programmes (NMPs) to implement subnational tailoring (SNT) – the systematic use of local data and contextual information to determine the most appropriate combinations of interventions and optimal resource allocation for specific geographical areas (districts, health facility catchments, or villages). The approach recognizes that malaria transmission varies significantly within countries due to climate, ecology, socioeconomic factors, health systems, and intervention history, requiring locally adapted strategies rather than uniform national approaches.
The manual outlines a 10-step implementation process integrated with the malaria planning and implementation cycle, spanning 6–12 months: planning and preparedness; data assembly and management; situation analyses; stratification of malaria risk and determinants; intervention tailoring and prioritization; forecasting impact through mathematical modelling; selecting strategic scenarios for the national malaria strategic plan (NMSP); optimizing within available resources; service delivery; and monitoring and evaluation. Each step is supported by detailed technical annexes covering transmission continuum concepts, effective coverage estimation, stratification methods, intervention-specific guidance (ITNs, IRS, larval source management, case management, chemoprevention, vaccines), mathematical modelling, costing, and cost-effectiveness analysis.
The manual emphasizes that SNT is not a separate process but integrates with existing NMSP development and review cycles. It builds on principles of country ownership, evidence-informed decision-making, value-based health care, and the Paris Declaration on Aid Effectiveness. The approach is applicable across all transmission settings from high burden to elimination, though methods may need adaptation for very low transmission areas requiring finer spatial resolution and case-based surveillance.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Stratify malaria risk at the operational unit level (district, health facility catchment) using prevalence, incidence, mortality, and determinants including vector species, seasonality, intervention coverage, and ecological factors.
- Define transmission levels using indicative thresholds: high ≥450 cases/1000/year or PfPR ≥35%; moderate 250–450 cases/1000/year or PfPR 10–35%; low 100–250 cases/1000/year or PfPR 1–10%; very low <100 cases/1000/year or PfPR >0 and <1%.
- Deploy ITNs where PfPR2–10 >1% as an operational marker, with next-generation ITNs prioritized in highest burden zones with documented insecticide resistance.
- Implement seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine monthly during transmission season for children at high risk of severe malaria in seasonal transmission areas.
- Provide perennial malaria chemoprevention (PMC) using sulfadoxine-pyrimethamine or artemisinin-based combination therapy (ACT) to children aged 5–24 months in moderate to high year-round transmission areas.
- Deliver malaria vaccination in four-dose schedule starting at 5 months in moderate to high transmission areas; consider a fifth dose 1 year after the fourth in highly seasonal transmission or where malaria risk persists into the third year of life.
- Provide intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine at each antenatal visit from second trimester, with doses at least 1 month apart, aiming for three or more doses.
- Establish national malaria data repositories (NMDR) integrating epidemiology, entomology, vector control, chemoprevention, finance, and population data to support analysis and dashboard visualization for decision-making.
Summary of objectives, key actions and key outputs for each step of the SNT process
Table extracted from the guideline
| Step | Objective | Key actions | Key outputs |
|---|---|---|---|
| 1. Planning and preparedness | Align SNT activities with national priorities and build readiness | Formulate objectives, establish teams, identify funding | Detailed workplan with timelines, roles and responsibilities |
| 2. Data assembly and management | Collect, organize and manage data required for SNT | Identify data sources, clean and validate datasets, assess quality, integrate into NMDR | Comprehensive validated dataset; data quality assessment report |
| 3. Situation analyses | Analyse malaria burden and transmission drivers | Map baseline and current transmission, assess health system readiness, identify high-burden areas | Analytical report summarizing burden, transmission drivers, intervention impact, programme performance |
| 4. Stratification | Identify appropriate interventions based on local contexts | Compile potential interventions, assess feasibility, stratify malaria burden and determinants | List of interventions with eligibility criteria; stratified risk maps by operational unit |
| 5. Intervention tailoring and prioritization | Develop tailored and prioritized intervention combinations | Design intervention combinations, provide subnational recommendations | Scenarios of intervention combinations tailored and prioritized |
| 6. Forecasting impact | Evaluate potential impact and cost-effectiveness | Model intervention combinations, analyse cost-effectiveness, identify trade-offs | Comparative analysis of scenario-based impact projections with costs |
| 7. Selecting strategic scenario | Finalize most impactful evidence-based combinations for NMSP | Conduct stakeholder consultations, finalize prioritized scenarios | Costed NMSP with funding gap analysis and resource mobilization strategy |
| 8. Optimizing within resources | Develop rationalized costed plan within budget constraints | Assess budget scenarios, optimize costs against different envelopes, document trade-offs | Finalized costed operational plan; documentation of trade-offs |
Source: World Health Organization, Subnational tailoring of malaria strategies and interventions: Reference manual. Reproduced in summary form.
From the guideline
Verbatim
“SNT is the use of local data and contextual information to determine the appropriate combination of interventions and strategies and best allocation of resources for a given area, such as a district, health facility catchment or village, for maximum impact on transmission and burden of disease, within the context of value-based health-care delivery through an inclusive process.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on health systems strengthening in the South Caucasus, I recognise that while Georgia has eliminated malaria, this manual's methodological rigour is directly applicable to our surveillance-response systems for preventing reintroduction. The stratification framework for identifying high-risk border areas and mobile populations, combined with the emphasis on integrated data repositories, aligns perfectly with Georgia's NMDR development and our regional collaboration on cross-border health threats. I would stress to colleagues in our Public Health Institute the value of the 10-step analytical process for any disease programme requiring subnational resource optimization – the principles apply equally to tuberculosis hotspot identification or hepatitis C micro-elimination efforts. The realistic caveat is that mathematical modelling capacity remains limited in our region; investing in local analytical expertise and partnerships with technical institutions, as the manual recommends, will be essential before these methods can be routinely applied to inform our strategic planning cycles.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
While Georgia achieved malaria elimination in 2010 and currently focuses on preventing reintroduction through surveillance of imported cases along its borders with endemic countries, this manual offers valuable insights for strengthening surveillance-response systems and risk stratification in very low transmission settings. National programmes in Georgia and neighbouring South Caucasus countries (Armenia, Azerbaijan) managing residual foci or importation risk can apply the principles of subnational data analysis, mathematical modelling for outbreak preparedness, and resource optimization to maintain elimination status. For Eastern European countries supporting malaria programmes in endemic regions through technical assistance or managing imported cases in mobile populations, the manual provides a comprehensive framework for evidence-based planning. The emphasis on integrating malaria data repositories with broader health information systems aligns with Georgia’s ongoing digital health transformation and universal health coverage initiatives.
Questions this guideline answers
Quick answers
What is the recommended duration for the complete SNT process?
The complete SNT process to inform strategic planning is recommended to take 6–12 months, with overlapping steps. Planning and data assembly begin concurrently (1 month), data management continues for 3–4 months, situation analyses and stratification take 2–4 months, and forecasting, scenario selection, and optimization run partially in parallel over 4–6 months.
At what spatial resolution should malaria risk stratification be conducted?
In high transmission settings, stratification should be conducted at subnational operational units such as districts, health zones, provinces or regions. As countries progress toward elimination, finer scale mapping is required at the level of localities or health facility catchment areas, ideally using case-based data rather than prevalence surveys.
How should effective coverage be calculated for malaria interventions?
Effective coverage is the fraction of an at-risk population fully protected by an intervention, accounting for three gap types: coverage gaps (proportion reached), effectiveness gaps (impact limitations due to resistance or other factors), and residual transmission gaps (persistence of transmission despite full coverage and effectiveness). It is substantially lower than simple coverage metrics like net ownership or facility attendance.
What are the key components of a national malaria data repository (NMDR)?
An NMDR is a centralized data warehouse integrating all malaria-related data including epidemiology, entomology, vector control, chemoprevention, finance, and population denominators. It should link to geocoded administrative boundaries, support analytical dashboards for visualization, establish clear data access mechanisms for stakeholders including frontline workers, and include governance for data quality monitoring and regular updates.
Related on GMJ
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Other guidelines on this topic
- Guidance for Developing Status Profiles on Communicable Diseases to Further Progress toward Their Elimination in the Region of the Americas
- Manual for Stratifying Malaria Risk and the Elimination of Foci
- Malaria case management: Plasmodium vivax malaria – A field guide
- Manual for respiratory virus vaccination coverage: monitoring and reporting seasonal influenza, COVID-19, and respiratory syncytial virus immunization
- User manual for the Member State Rapid Risk Assessment (MS-RRA) tool
- Issuer
- World Health Organization
- Type
- Manual
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-10-09
- Scope
- All malaria transmission settings from high burden to elimination; national and subnational malaria programme planning
- Audience
- National malaria programmes, subnational malaria coordinators, implementing partners, technical experts supporting SNT, international and domestic funding agencies
- Pages
- 185
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011571-2
- Evidence
- Expert consensus integrated with WHO normative guidance; consolidates methods from High Burden to High Impact approach and elimination country experiences
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
World Health Organization. Subnational tailoring of malaria strategies and interventions: reference manual. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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