Health-system readiness for integrating ceiling nets into malaria vector control in Kenya: perspectives of health managers

Malaria transmission has been reduced considerably in some Kenyan regions; however, it remains high in the Lake Victoria basin. Ceiling nets fall under house screening as interventions in vector control under the World Health Organizations Guidelines on Malaria and has a conditional recommendation with low-to moderate-certainty evidence of impact against malaria. This study aimed at assessing the perceptions of health system managers on the health system readiness in integrating ceiling nets into malaria vector control in and implementation pathways.A cross-sectional, qualitative, action research design was used aimed at providing actionable solutions to health systems challenges in the inclusion of ceiling nets as a complementary vector control strategy in the comprehensive approach on malaria prevention in Suba West sub-county, Homa Bay county. Key-informant interviews on perspectives on health system readiness for ceiling net integration into routine programmatic vector control strategies were conducted among health system managers. Qualitative data was captured using audio tapes and field notes, transcribed and analyzed using case-based in-depth inductive and deductive analysis using a thematic framework to classify and organize data into themes.Key emergent themes included perception and experiences in malaria vector control strategies, role of community health in malaria vector control strategies, systemic barriers and facilitators in malaria vector control, perspectives on integration of the ceiling nets in malaria vector control. This study demonstrates that health system managers perceive ceiling nets as a feasible, acceptable, and operationally integrablecomplement to existing malaria vector control strategies, while also identifying concrete system bottlenecks that must be addressed for scale-up. The ceiling nets showed high acceptability, appropriateness of fit in structurally heterogenous housing structures and high feasibility as an addition to a comprehensive complementary vector control strategy.The findings inform decision-ready implementation pathways of complementary ceiling nets in existing vector control strategies. Ceiling nets are perceived by frontline health system managers as a system-ready, acceptable house-modification intervention that can close critical protection gaps left by bed-net-centric malaria control, provided community health platforms and supply chains are deliberately leveraged. Successful scale up implementation hinges on a structured approach of integration that includes community buy-in, task-shifting of community health promoters in ceiling net installation, effective supply chains, and robust monitoring and evaluation systems to track, maintain and assess system level indicators and community level indicators.