Barriers to the functionality and responsiveness of the malaria surveillance and data use system in Cameroon: a qualitative cross-sectional study

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. 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. 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. 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.