Policy-practice gaps and barriers to the effective management of insecticide resistance in Tanzania

Abstract

BACKGROUND: Malaria control gains are stagnating or reversing, in part due to widespread insecticide and drug resistance, as well as increasing financial and implementation challenges. This study assessed the national strategies for insecticide resistance monitoring and management in Tanzania to identify key barriers and misalignments between policy and actual practice. METHODS: We initially reviewed technical documents from Tanzania's National Malaria Control Programme (NMCP) produced between 2014 and 2024, along with World Health Organization (WHO) guidelines and reports on insecticide resistance monitoring and management. This was followed by in-depth interviews with key informants in Tanzania, including policymakers, representatives from funding agencies, technical experts, scientists, and vector control implementers at district and regional levels. The qualitative data was analyzed thematically using NVivo software. FINDINGS: The document review revealed strong policy alignments of the NMCP strategies for monitoring and management of insecticide resistance with international practice as recommended by WHO. However, implementation of the policy intentions remained limited, with resistance monitoring being conducted in only 22 of Tanzania's 184 district councils. Interviews with 24 stakeholders highlighted significant gaps between the stated policies and guidelines and the actual practice. These gaps were driven by inadequate financing, donor dependence, insufficient coordination and dissemination of guidelines, limited technical capacity, and weak engagement of communities and district-level operators. Participants emphasized that without strengthened surveillance systems, sustainable local financing, and greater community and intersectoral collaboration, achieving the current strategic goal of malaria elimination by 2030 remains unlikely. CONCLUSION: Despite strong policy alignment and strategic planning, Tanzania's capacity to implement insecticide-resistance management initiatives remains constrained by several policy-practice gaps, particularly in funding, staffing and coordination. Addressing these persistent challenges will be essential for more effective malaria vector control and will require sustained financing, stronger coordination, improved vector monitoring, and greater community and intersectoral engagement.