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Slide 1 - Monitoring and Evaluation: Malaria-Control Programs
Slide 2 - 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
Slide 3 - 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
Slide 4 - 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
Slide 5 - 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
Slide 6 - 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
Slide 7 - Malaria mortality Treatment: Early diagnosis & treatment Health care system: Accessibility Affordability Quality of care Efficiency Demand/utilization Program factors: Health policy Anti-malarial drug policy Support/partnership National MCP Malaria knowledge: Cause Prevention methods Early treatment Cultural beliefs Information Prevention: ITNs, IRS, IPT Environmental mgt External factors: Environmental (ecological, climate) Socio-economic (economic status, movement, occupation, housing condition, war, population displacement, etc) Demographic ( age, immunity, gender) Malaria infection Malaria morbidity Conceptual Framework (MCP)
Slide 8 - 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
Slide 9 - 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
Slide 10 - 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
Slide 11 - 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
Slide 12 - 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
Slide 13 - 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
Slide 14 - Basic Malaria M&E Framework
Slide 15 - 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
Slide 16 - SO1: Reduced Malaria Burden IR1: Improved malaria prevention IR2: Improved malaria epidemic prevention & management IR3: Increased access to early diagnosis & prompt treatment of malaria IR3.1 Quality of care improved IR3.2 Efficiency in service delivery improved IR3.3 Utilization of care improved IR1.1 Access to & coverage by ITNs increased IR1.2 Improved access to IPT IR1.3 IRS coverage increased in Epidemic-prone areas IR1.4 Use of source reduction/ larviciding increased IR2.1 Early detection & appropriate response improved IR2.3 Surveillance system improved IR2.2 Epidemic preparedness improved IR2.4 Early warning system strengthened Results Frameworks (MCP) IR3.4 Access to services improved
Slide 17 - Logical Framework (MCP)
Slide 18 - Logical Framework (MCP)
Slide 19 - Level and function of M&E indicators
Slide 20 - RBM Core Coverage Indicators
Slide 21 - 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
Slide 22 - 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
Slide 23 - 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
Slide 24 - 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?
Slide 25 - References World Health Organization and UNICEF. 2005. World Malaria Report 2005. Geneva: WHO.