Posts or Comments 23 May 2024

Monitoring &Morbidity Bill Brieger | 24 Jun 2008 05:32 am

Counting down the cases

Malaria cases are dropping according to a United Nations press release described in the British Medical Journal. “… the figures show that the fund has delivered 59 million bed nets impregnated with insecticide to families at risk of catching malaria, almost double the number that were issued a year ago. Michel Kazatchkine, the fund’s executive director, said there was now clear evidence that mortality rates from the disease among children younger than 5 years of age had fallen sharply in 10 sub-Saharan countries, and, in Zanzibar, malaria had been almost eradicated as a public health problem.”

Likewise, Destination Sante exclaims that, “Rolling back malaria really is possible ! Between 2005 and 2007, the authorities in Rwanda and Ethiopia succeeded in reducing the number of cases of malaria and deaths from the disease on their territory by 60%. This victory is the result of close coordination with international sponsors.”

  • Le Rwanda par exemple, a réduit de 64% le nombre des infections et de 66% les décès chez les enfants de moins de 5 ans. (In less than two years, Rwanda, for example, reduced the number of infections by 64% and deaths among the under-5s by 66%.)
  • En Ethiopie voisine, les succès sont tout aussi encourageants : 55% de transmissions en moins, et 60% de morts évitées. (In neighbouring Ethiopia, the story is just as encouraging: 55% fewer transmissions and 60% of deaths avoided.)

The Lancet, where this information was published earlier, asks how these successes happened and what lessons can be learned for scaling up elsewhere. Chambers et al., in The Lancet explain that, “The case of Ethiopia is especially informative, because this is the first time such significant achievements have been recorded over such a large geographical area in sub-Saharan Africa.” They identified four key components of success that made scale-up in three years possible:

  1. a catalytic moment,
  2. demand for universal coverage,
  3. pragmatic donor response, and
  4. innovative problem-solving

The authors offer this crucial piece of advice: “Donors must also be willing to assume greater risk by encouraging and funding ambitious programmes while showing increased flexibility in their processes and procedures. And both parties must plan early for the maintenance and eventual elimination phases so that donor support does not flag as malaria deaths are reduced.”

m-and-e.jpgFinally it is important to observe that these claims of progress could not be made without a system of monitoring and evaluation.  Are the interventions reaching the people? Are they actually using the nets and medicines? Are health systems employing the correct diagnostic tools to determine whether cases of malaria are really dropping?  The Global Fund, being performance based, provides tools to answer these questions.  We encourage all countries who are not writing their Round 8 Global Fund proposals to take advantage of these tools and write strong monitoring and evaluation components into their grants.

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