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Monitoring and Evaluation: Malaria-Control Programs. Learning Objectives. By the end of this session, participants will be able to: Realize why malaria is important Describe a conceptual framework for malaria Describe Roll Back Malaria technical strategies

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Monitoring and evaluation malaria control programs

Monitoring and Evaluation:Malaria-Control Programs

Learning objectives
Learning Objectives

By the end of this session, participants will be able to:

  • Realize why malaria is important

  • Describe a conceptual framework for malaria

  • Describe Roll Back Malaria technical strategies

  • Design an M&E framework for national-level malaria-control programs

  • Identify core population coverage indicators of the RBM strategy & recognize their strengths & limitations

Content outline
Content Outline

  • Introduction

  • Current situation of malaria control

  • Conceptual framework for malaria control

  • RBM-control strategies

  • International and regional targets

  • Results and logical frameworks for malaria

  • Level and function of M&E indicators

  • M&E indicators for malaria

  • Strengths and limitations of indicators

Why is malaria important problem statement
Why is Malaria Important?Problem Statement

  • 300-500 million cases and >1 million deaths annually

  • Malaria during pregnancy in malaria-endemic settings

    may account for:

    • 2-15% of maternal anemia

    • 5-14% of low birth-weight newborns

    • 30% of “preventable” low birth-weight newborns

    • 3-5% of newborn deaths

  • Malaria accounts for one in five of all childhood deaths in Africa every year.

  • Malaria epidemic causes >12 million malaria episodes & up to 310,000 deaths in Africa annually

  • Drug resistance exacerbates the malaria problem

  • Introduction to mcp 1
    Introduction to MCP (1)

    • Historical

      • 1950s Global malaria-eradication program

      • As a result, malaria was eradicated from many countries

      • 1960s global eradication stopped

        • Insecticide resistance

        • Drug resistance

        • Poor infrastructure, particularly in Africa

      • Eradication program changed to malaria control

      • During 1970s and 1980s malaria received little attention

    Introduction to mcp 2
    Introduction to MCP (2)

    • Current situation

      • Malaria reemerged as a major international health issue in the 1990s

      • Global malaria control strategy adopted in 1992

      • Roll Back Malaria 1998

      • Abuja Declaration 2000

      • Strong political commitment and partnership

    Conceptual Framework (MCP)

    • External factors:

    • Environmental (ecological, climate)

    • Socio-economic (economic status, movement,

    • occupation, housing condition, war, population

    • displacement, etc)

    • Demographic ( age, immunity, gender)



    • Prevention:

    • ITNs, IRS, IPT

    • Environmental mgt

    • Health care system:

    • Accessibility

    • Affordability

    • Quality of care

    • Efficiency

    • Demand/utilization




    Early diagnosis

    & treatment



    • Program factors:

    • Health policy

    • Anti-malarial drug policy

    • Support/partnership

    • National MCP

    • Malaria knowledge:

    • Cause

    • Prevention methods

    • Early treatment

    • Cultural beliefs

    • Information

    Roll back malaria
    Roll Back Malaria

    • Partnership launched in 1998

      to fight malaria

    • WHO, UNDP, UNICEF and WB

    • Mainly focuses on Africa

    • Goal:

      • Halve the burden of malaria by 2010

    Millennium development goals
    Millennium Development Goals

    • Target 8: Have halted and begun to reverse the incidence of malaria and other major diseases by 2015

      • Indicator 21. Prevalence and death rates associated with malaria

      • Indicator 22. Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures

    African summit on rbm
    African Summit on RBM

    • Abuja summit 2000

    • 44 heads of state or senior representatives from malaria-afflicted countries in Africa

    • Endorsed the goal of RBM

    • Reflected high political commitment

    Abuja targets by 2005
    Abuja Targets: By 2005

    • At least 60% of those suffering from malaria should be able to access and use correct, affordable, and appropriate treatment within 24 hours of the onset of symptoms

    • At least 60% of those at risk of malaria, particularly pregnant women and children under five years of age, should benefit from suitable personal and community protective measures such as ITNs

    • At least 60% of all pregnant women who are at risk of malaria, especially those in their first pregnancies should receive IPT

    Rbm strategies
    RBM Strategies

    • Use of ITNs and other locally approved means of vector control

      • Children <5 (and pregnant women)

        2. Prompt access to effective treatment

      • Children <5

        3. Prevention and control of malaria in pregnancy

      • Intermittent preventive treatment (IPT) & ITNs

        4. Early detection of and response to malaria epidemics

    Roll back malaria m e
    Roll Back Malaria M&E

    • Extensive & systematic M&E relatively new for national malaria control programs

    • M&E reference group (MERG) established

    • Objectives of national RBM M&E system

      • Collect, process, analyze, and report malaria-relevant information

      • Verify whether activities implemented as planned

      • Provide feedback to relevant authorities

      • Document periodically whether planned strategies have achieved expected outcomes & impact

    M e priorities in limited resource settings
    M&E Priorities in Limited Resource Settings

    • Human & financial inputs

    • Malaria control services delivered to those at risk of malaria

    • Coverage of interventions

    • Malaria-associated morbidity & mortality

    Results Frameworks (MCP)

    SO1: Reduced

    Malaria Burden

    IR2: Improved malaria

    epidemic prevention

    & management

    IR1: Improved

    malaria prevention

    IR3: Increased access

    to early diagnosis &

    prompt treatment of


    IR1.1 Access to &

    coverage by ITNs


    IR2.1 Early detection

    & appropriate response


    IR3.1 Quality of

    care improved

    IR2.2 Epidemic

    preparedness improved

    IR1.2 Improved

    access to IPT

    IR3.2 Efficiency in

    service delivery


    IR2.3 Surveillance

    system improved

    IR1.3 IRS coverage

    increased in

    Epidemic-prone areas

    IR3.3 Utilization of

    care improved

    IR1.4 Use of source

    reduction/ larviciding


    IR2.4 Early warning

    system strengthened

    IR3.4 Access to

    services improved

    Core population coverage indicators for RBM





    Outcome Indicators





    Indicators for monitoring the performance of malaria programs / interventions, measured at the program level

    Indicators for evaluating results of malaria programs / interventions, measured at the population level

    Level and function of M&E indicators

    M e challenges of national mcps measuring impact
    M&E Challenges of National MCPs: Measuring Impact

    • Not routinely required…technical strategies already proven efficacious for these indicators of impact, so coverage should suffice

      • debatable

  • Requires rigorous experimental design

  • Technical strategies intended to be full-coverage programs

  • Costly

  • M e challenges of national mcps
    M&E Challenges of National MCPs

    • Measuring malaria-specific morbidity & mortality

      • Case definitions

      • Variations in completeness of reporting over time and space

      • Selectivity

      • Time frame of survey estimates

      • Low coverage & quality of vital registration

    M e challenges complexity of malaria epidemiology
    M&E Challenges: Complexity of Malaria Epidemiology

    • Not a linear relationship between transmission (immunity) and malaria-related mortality

    • Severity and symptomology of malaria morbidity shifts with transmission (immunity)

      • High transmission = chronic infections, severe anemia

      • Low transmission = higher life-threatening severe malaria

  • Coverage is primary outcome indicator for national- level MCP

  • Class activity
    Class Activity

    Malaria is the most frequent cause of morbidity and mortality in Malawian children under five years of age, and is the cause of over 40% of deaths in children under two. Children under five suffer on average 9.7 malaria episodes per year, while adults suffer 6.1 such episodes (Ettling et al., 1994a). The cost of malaria to the average Malawian household has been estimated to be 7.2% of average household income. PSI/Malawi is reducing malarial disease and death by increasing ownership and appropriate use of ITNs.

    Q. Describe the various components of the PSI program that need to be monitored?


    • World Health Organization and UNICEF. 2005. World Malaria Report 2005. Geneva: WHO.