Projects & Programmes
Where we have worked and learned
Projects & Programmes
Where we have worked and learned
Current Project: OPTiMIX — Optimising The Mix Of Malaria Prevention tools
Active 2025–2026 | Partners: LSHTM, ISPIM, Finistech | Countries: Cameroon and Côte d'Ivoire | Districts: Guider, Soa (Cameroon); Kani, Séguela (Côte d'Ivoire)
LUGF is implementing the LEAD Framework in Cameroon and Côte d'Ivoire as part of OPTiMIX — a multi-country project focused on improving uptake of the malaria vaccine (R21/Matrix-M) and integrating its delivery with other proven prevention tools: PBO-LLINs (insecticide-treated nets), Perennial Malaria Chemoprevention (PMC), and seasonal malaria chemoprevention (SMC).
The project recognises that the malaria vaccine alone is not enough — real impact depends on coordinated, integrated delivery across the whole prevention mix. LEAD provides the management and leadership infrastructure to make that coordination at district level a reality.
Phase 1 achievements (February–March 2026)
- Facilitator capacity built: 10 local LEAD facilitators trained (6 Cameroon, 4 Côte d'Ivoire) in participatory approaches, systems thinking, root cause analysis, and a QI-based Model for Improvement.
- National Task Forces established in both countries: high-level workshops convened with Ministries of Health, National Malaria Control Programmes, Essential Programmes on Immunization, and partners. Task Forces provide strategic oversight and link national policy to district delivery.
- District Task Teams formed in all four districts: each equipped with action plans, improvement indicators, and quarterly review cycles.
- Priority challenges identified using LEAD methods (system in the room, problem trees, root cause analysis): geographic access, health workforce gaps, supply chain fragility, vaccine hesitancy, data quality, and coordination failures — with local solutions under development.
This Project Is Jointly Funded By The UK Medical Council (MRC) and The UK Foreign, Commonwealth & Development Office (FCDO)
Grant Number (UKRI751)
Previous Programmes: ODME — Organisational Development for Malaria Elimination
Countries: Zimbabwe, Eswatini, Namibia | Funder: Gates Foundation
The original application of LEAD, piloted in Eswatini and Zimbabwe. Task teams across provinces achieved significant improvements in malaria case investigation, drug stock levels, and community coverage of malaria prevention and treatment. The approach was adopted as Zimbabwe’s national standard for malaria elimination.
Building on this foundation, ODME introduced a breakthrough in malaria programme performance by addressing the “missing middle” of health systems: management, coordination, and local problem-solving. Using participatory organisation development and quality improvement methods, multidisciplinary district teams were empowered to diagnose operational barriers, design context-specific solutions, and act within their authority. This shifted programmes from compliance-driven delivery to locally owned performance improvement—strengthening motivation, accountability, and cross-level collaboration. Evidence shows improved data quality, faster case investigation, reduced drug stockouts, and stronger teamwork, alongside a profound change in mindset: frontline staff gained the confidence and capability to solve problems and drive results where they matter most.
Previous Programmes: Namibia: LEAD Project Summary (2019–2021)
Countries: Namibia | Funder: Gates Foundation
Strengthening Leadership
In Namibia, a Bill & Melinda Gates Foundation funded LEAD intervention strengthened leadership across Kavango East and West by training 12 health professionals in a University of the West of England-accredited change leadership programme—the postgraduate certificate in Professional Practice in Change Leadership—enabling them to facilitate Task Teams and lead operational improvements. Participatory workshops brought national, regional, district, facility, and community actors together, building shared ownership, communication skills, and a stronger culture of accountability in programme management.
Integrating Systems
The intervention integrated subnational systems by establishing cross disciplinary Task Teams, embedding structured problem solving cycles, and creating more direct communication channels between district teams and the National Vector borne Diseases Control Programme. Malaria activities were incorporated into Regional Council operational plans, and multisectoral collaborations—including local political leadership and civil society—were strengthened to enhance coordination and data flow across administrative levels.
Improving Delivery
Namibia recorded significant delivery improvements: malaria case reporting increased from 60% to 100%, cross border case-tracing rose by 32%, and case management improved by around 10%. Teams improved surveillance practices, community engagement, and operational planning, with LEAD methods becoming institutionalised within routine health system structures—supporting sustainability and ongoing service delivery improvements beyond the intervention period
Previous Programmes: OPTIMISE — Integrating and Sustaining a Vertical HIV Programme
Country: Zimbabwe | Published: BMJ Global Health; PLOS Global Public Health
Building on the foundational work with ODME, OPTIMISE applied the LEAD approach to a pressing global health challenge: embedding a large, donor-funded and partner-driven HIV prevention programme into routine government services. Multilevel Task Teams enabled district health systems to take ownership of voluntary medical male circumcision (VMMC), redesigning delivery models, mobilising local resources, and integrating planning, budgeting, and performance management.
The project demonstrated a practical pathway from a vertically run programme to a sustainable, locally led system. Districts improved service accessibility and uptake, strengthened workforce capacity, enhanced data quality, and embedded VMMC in governance structures and routine operations. Crucially, OPTIMISE addressed both structural and psychological barriers to transition—shifting mindsets from donor dependence to local accountability, while empowering subnational leaders to diagnose and solve problems. The result was not only improved programme performance, but durable organisational capacity and a replicable model for integrating priority health programmes at scale.
Previous Programmes: District-level Health System Strengthening
Districts: Hwange and Nyanga, Zimbabwe
LEAD was applied to cross-cutting health system challenges — HIV viral load monitoring, maternal mortality, COVID-19 vaccination, and measles coverage. Results show how LEAD's impact spreads beyond any single disease programme.
Crucially, these gains were not programme-specific but system-shaping. By working through routine management platforms, LEAD enabled districts to align financing, workforce deployment, data systems, and service delivery across multiple priorities, breaking down the silos characteristic of vertical programmes. The same problem-solving routines used to strengthen VMMC were applied to logistics, supervision, and community engagement more broadly, generating spillover benefits for maternal health, immunisation, and primary care services. In this way, LEAD functioned as a cross-cutting capability—building adaptive, learning-oriented health systems able to respond dynamically to resource constraints while sustaining gains beyond any single intervention.