Monitoring and Evaluation in Malaria Control Programmes: An Overview

In nations where malaria is still endemic, the effective implementation of vector control measures and the enhancement of case detection and management have been made possible by increasing financial assistance and the fortification of the local health system. Multidrug-resistant parasites pose a threat to these advancements. Additionally, one of the main causes of the malaria recurrence is the deterioration of control programs, which results in a localised suspension of service delivery. 

To accomplish elimination goals, vigilance must be maintained. In order to successfully achieve eradication targets and minimise morbidity and mortality, it is imperative that all individuals living in endemic regions have continuous access to early diagnosis and appropriate treatment for malaria. In areas where there are sociocultural, political, topographical, and economic constraints, this continues to be difficult.

Programmes to eradicate malaria must be funded in order to function, and they must show that their efforts are having a positive effect. Furthermore, epidemiological surveillance is an essential part of the eradication process. Thus, it is necessary to have robust information systems in place for data gathering, with the goal of using the data to enhance and inform program operations.

Measures of service uptake, diagnostic and treatment availability, and MPW performance and knowledge can all be obtained through monitoring and evaluation (M&E) operations. These include reporting stocks of RDTs and ACT medications, using artemisinin-based combination therapy (ACT), and maintaining accurate records of RDT use and results. M&E reports serve as a useful data source for assessing the effectiveness and impact of programs and can also be utilised as a tool for additional intervention. 

Aims of Monitoring and Evaluation

“Monitoring” is the process of collecting and analysing data on the weekly, monthly, quarterly, or annual execution of programs with the goal of making required adjustments and confirming that programs are operating satisfactorily. Monitoring frequently involves tracking inputs, outputs, and processes using administrative data; program outcomes and impacts may also be included.

“Evaluation” refers to a more thorough appraisal of a program; it is typically conducted at specific intervals and covers the impacts and longer-term results of programs. Enhancing program effectiveness, efficiency, and equity is the aim of monitoring and evaluation. They are essential for tracking progress toward the GTS (Global technical strategy for malaria 2016–2030) objectives and accomplishing the aims of national programs. 

Plans are established to guarantee the most efficient use of resources to either eradicate malaria or lessen its impact on public health after the situation with regard to malaria in a nation or region has been evaluated. Plans should be routinely reviewed once they are put into action to see if any adjustments are needed or if the program’s actions are producing the expected results.

High-quality, timely information is vital for programme design and implementation, and the information can also be utilised to lobby internal and external stakeholders for the necessary resources. By increasing public access to information on program planning and monitoring, malaria programs can also function better. Information made available to the public promotes management to better understand the demands of their clients and enables lawmakers, patients, and other citizens to keep an eye on the services they are funding.

The main goal of gathering data on malaria programs is to support local decision-making and action. Through reports released by the UN and WHO, data obtained at the national level is also utilised to inform advancements at the global level. The information helps international financiers understand malaria programs and plays a significant role in deciding future funding.

Major functions of monitoring and evaluation 

Monitoring and evaluation can accelerate progress towards malaria elimination if used to: 

  1. regularly assess whether plans are progressing as expected or whether adjustments are required to the scale of the intervention or combination of interventions; 
  2. allocate resources to the populations most in need in order to achieve the greatest possible public health impact; 
  3. account for the funding received to allow the public, their elected representatives and donors to determine whether they are obtaining value for money; 
  4. evaluate whether the programme objectives have been met and to learn what has worked and what has not, so that more efficient, effective programmes can be designed;
  5.  advocate for investment in malaria programmes in accordance with the malaria disease burden in a country or subnational area; and 
  6. track progress toward elimination.

Types of Information required for monitoring

Information may be informal, semi-formal or formal. 

  • Informal information is learnt by observation, talking to health staff or community leaders and other informal means. 
  • Semi-formal information is obtained, for example, from policy documents, consultants’ reports, supervisory visits, focus group discussions, official circulars and minutes of meetings. 
  • Formal information is acquired from ordered systems for recording and reporting information, such as routine health information and surveillance systems, accounting systems and surveys.

Formal information for programme monitoring can be obtained from: 

  1. routine health information systems, which may either cover a number of programmes, be specific to malaria or be limited to certain activities (e.g. laboratory services, interventions, distribution, surveillance); 
  2. health facility surveys, which usually address whether facilities have the physical and human resources necessary to provide services (especially chemoprevention, diagnostic testing and treatment), and may include whether patients receive diagnostic testing and appropriate treatment; 
  3. household surveys, which usually cover several health interventions, especially for children under 5 years of age and women of reproductive age, although malaria-specific surveys are also common; 
  4. operational research, which usually addresses specific questions of relevance to the malaria programme, may rely on household or health facility surveys and may include studies of drug or insecticide efficacy; 
  5. entomological surveillance, for understanding the distribution of the main malaria vectors, their behaviour and changes in their biting habits in response to the intervention; part of sentinel surveillance by national programmes and often including vector resistance to insecticides; 
  6. data from supervision of health services (central, intermediate, health facility and health worker levels); and 
  7. contextual data, which are not collected routinely or during operational research but are useful for further understanding and explanation of changing trends in the malaria burden. They include population censuses and climate and socioeconomic data.

Program data for continuous monitoring and routine health information systems are typically the sources of data for program monitoring. Data from routine systems may be supplemented with information from household and health facility surveys (e.g., to compare values of indicators collected in normal systems and health facility surveys). When routine systems function properly, they can offer data continually from all districts or equivalents across a nation. If other variables remain constant, they can also be utilised as early warning systems for potential epidemics or to detect changes in intervention coverage over time and geography. 

Incomplete coverage of health information systems can result in a biased sample of the services used by communities. Often, they do not include private clinics and other non-government facilities or cases treated by village health workers or at home. In addition, routine systems seldom function optimally; there is often inconsistent application of reporting definitions and irregular reporting from health facilities and districts to central level. Trends in indicators of intervention coverage are therefore prone to variations in reporting rates. It is important to track the completeness of reporting, not only as an indicator of the functioning of the information system but also for interpreting trends in other indicators.

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