Over the past decade, funding for malaria programs has increased significantly, especially in Sub-Saharan Africa. This has led to scaling up key interventions such as insecticide-treated nets, indoor residual spraying and intermittent preventive treatments for pregnant women.
Formal evaluations of the impact of these interventions are important to determine their effectiveness in improving public health. They also can inform updates to strategic plans for controlling malaria, account for donor funds and bolster a case for renewing grants.
Launching the Evaluation in DRC
Since 2011, MEASURE Evaluation has provided technical and administrative support to the U.S. President’s Malaria Initiative (PMI) to evaluate the impact of interventions to control malaria in 16 priority countries, including the Democratic Republic of the Congo (DRC). The evaluations cover all-cause child mortality, as well as morbidity and mortality related to malaria.
Dr. Olivier Kakesa, who has served as the resident advisor from MEASURE Evaluation in DRC since 2013, recently helped launch the evaluation in that country. “This is the first malaria impact evaluation under the National Malaria Control Program (NMCP),” he says. “The results are very important, because they should help demonstrate that the funds contributed to malaria control programs in DRC have had a positive effect on health outcomes.”
Setting the Stage
Before data collation/compilation and analysis can begin, evaluators must first get stakeholder buy-in and design the study. Dr. Kakesa and his team with support from ICF team in USA began meetings with stakeholders in January 2016.
“We met with colleagues from the United States Agency for International Development, PMI and NMCP to define our data sources and agree upon the purpose and structure of the project,” he says.
In May 2016, Dr. Kakesa and his colleagues presented their plans to key stakeholders at the Ministry of Health and selected a local research institution to support data analysis and report writing. “We expect final approval of our protocol in the coming days,” he says. “Meanwhile, we’re gearing up to start data collation.”
Collating/compiling High-Quality Data
Evaluators are collating data from many sources, including Demographic and Health surveys (DHS), Multiple Indicator Cluster Survey (MICS), the National Health Management and Information System (NHMIS), NMCP, the national immunization program and reports related to malaria morbidity and mortality in DRC.
“We already have reason to believe that mortality for children under 5 is decreasing,” says Dr. Kakesa, referring to the 2014 Demographic and Health Survey that showed the all-cause child mortality for that demographic had fallen from 148 in 1,000 in 2007 to 104 in 1,000 in 2013. “We hope this evaluation will show that an increase in malaria interventions during the same period correlates with that decrease in mortality.”
It is difficult to measure malaria-specific mortality at the population level, partly because the disease is unspecific and most death occurred outside the health care system without appropriate diagnosis. But in countries with high malaria burden, like DRC, malaria is a key contributor to all-cause child mortality. And data analyzed during the evaluation will account for other contextual determinants of child survival, including other interventions, climatic and environmental factors, health systems factors and socioeconomic factors affecting the country’s population.
“One way we can ensure credible evidence for our claims is to ensure the high quality of the data we include in this evaluation,” says Dr. Kakesa. “All the data used in this study will meet or exceed our predefined minimum quality standards.”
Dr. Kakesa hopes the evaluation findings will be published by the end of the year, and he’s excited to see the results. “If there’s a clear link between the increase in malaria interventions and the decrease in mortality under 5,” he says, “it will [help] the country to lobby for more life-saving resources.”