Abstract / Summary
Abstract Background Countries in the Greater Mekong Subregion are committed to eliminating malaria by 2030. Despite the critical role of health system readiness in malaria elimination, there is no assessment tool available to comprehensively evaluate an area’s readiness towards malaria elimination across six WHO health system building blocks which are service delivery, surveillance, elimination workforce, products and commodities, programme financing, and leadership and governance. The aim of this study is to develop a comprehensive health system readiness assessment tool for malaria elimination in the Greater Mekong Subregion. Methods Based on the findings from recent studies, a health system readiness assessment tool called STRIDE (Systems Tool for Readiness, Implementation anD malaria Elimination) was drafted. Two rounds of modified Delphi consultation were conducted during May and September 2025 to finalise and endorse the STRIDE with a priori percent agreement of 70%. A panel of experts consisting of representatives from national programmes, donor organisations, technical agencies, and implementing partners and independent experts evaluated the proposed items for assessing the health system readiness for malaria elimination. Content validity of the final STRIDE was assessed by item-level and scale-level content validity indexes. Results The draft STRIDE was developed with two modules: the National Module and the Sub-National Module comprising 58 and 49 questions respectively. The draft STRIDE underwent two rounds of online Delphi consultation with 24 and 18 experts. Incorporating expert feedback, the STRIDE was finalised with 66 questions in the National Module and 55 in the Sub-National Module, each assessing readiness across service delivery, surveillance, elimination workforce, products and commodities, programme financing, and leadership and governance for malaria elimination. Item-level content validity indexes of the questions ranged from 0.83 to 1.00, while scale-level content validity indexes were 0.96 for the National Module and 0.97 for the Sub-National Module, indicating excellent content validity. Conclusions The STRIDE offers a comprehensive, validated framework to evaluate an area’s readiness towards malaria elimination at multiple levels. It enables policymakers and programme managers to systematically evaluate elimination efforts, identify critical gaps, and strengthen national and sub-national health systems, thereby accelerating progress towards malaria elimination.