Getting started: For everyone

What Are SNT and SNT Analysis?

Subnational tailoring (SNT) is the tailoring of a country’s malaria response subnationally to account for and appropriately address local heterogeneities in malaria transmission, its determinants, and likely impact of various intervention strategies.

SNT is an evidence-informed, data-to-action process where many types and sources of data are considered together to inform the tailoring of the malaria response. The steps in the SNT process are intended to align with and provide additional evidence during standard malaria planning and implementation processes. WHO has developed guidance for countries on the development of national malaria strategic plans (NMSPs) and related programme reviews, operational plans and costing that are to align with national health sector plans. SNT should be nested within these processes and timelines: it is not a separate process, as it is aimed at directly informing the programme reviews, NMSPs, resource mobilization, and implementation.

The analysis steps of SNT include data assembly and management, situational analysis, stratification of malaria transmission and its determinants, review of past interventions, application of targeting criteria, mathematical modeling, and cost-effectiveness analysis. These analysis steps are interspersed with review, discussion, and validation by stakeholders under national malaria program (NMP) leadership to guide the analysis approach and make key decisions.

Full information on SNT is available in WHO’s SNT manual (coming soon).

If you are a national malaria program looking for technical assistance to conduct SNT, please contact the WHO Global Malaria Programme or the WHO Regional Office for Africa.

Roles

The SNT team is responsible for overseeing the entire SNT process, including analysis steps. It is led by the national malaria program and includes all relevant stakeholders for SNT.

The SNT team has a critical role in facilitating data access and assembly, giving direction to the analysis team, deciding on analytical approaches, validating (or not validating) results, and making decisions on which data is ultimately appropriate for which use, and how. Some SNT team members may also be part of the analysis team and directly participate in executing the analyses.

The analysis team is responsible for executing data management and analyses under the supervision of the SNT team. The analysis team has a responsibility to generate analysis outputs (e.g. descriptive analytics, stratification maps, intervention mix maps, decision trees, scenario analyses, modeling results, etc.), explain the analytical approaches used along with their strengths and limitations, present results clearly and transparently, bring up considerations for the SNT team to address, and revise the approaches according to the direction and decisions of the SNT team.

What to Expect from the SNT Process

While analysis is an important part of SNT, it is important to remember that the SNT process includes more than analysis. The full SNT process consists of ten steps:

  1. Planning and preparedness, including establishment of the SNT team

  2. Data assembly and management

  3. Situation reviews to understand the historical and recent epidemiological and intervention context

  4. Stratification of malaria epidemiology and its determinants

  5. Intervention tailoring

  6. Predicting the impact of intervention mix scenarios

  7. Developing costed strategic scenarios to generate a costed national strategic plan and preliminary prioritizations

  8. Optimizing strategic scenarios within available resources to generate costed operational plans

  9. Implementation and delivery of services

  10. Monitoring and evaluation of impact

The analysis team should work in tandem with the rest of the SNT team to support all steps of the process, where the analysis may play a more or less prominent role.

Please see WHO’s SNT manual for a full description of each step of SNT.

Who Should Use the SNT Code Library?

All are welcome to use and contribute to the SNT code library. We assume some basic knowledge of R, some understanding of the types of data often used in SNT, and that the user is participating in SNT analysis under the direction of a national SNT team. However, many elements of the code library may also be useful for general research and analysis work outside of a formal SNT process.

What Does the SNT Code Library Include?

The SNT code library includes code covering some of the most common data management and analysis steps of SNT up to but not including mathematical modeling, as well as some related analysis. Code included here stems from the experience of different analysts that have supported various countries and contexts through their SNT processes.

When multiple algorithmic options could be used, strengths and limitations of each one, along with discussion of when to use each option, are included as much as possible. The user will still need to decide, in discussion with their supervising SNT team, what option to implement, and will need to adapt the code to the specific database(s) with which they are working.