Evaluation of national malaria control programmes in Africa*
J. Bryce,' J.B. Roungou,2 P. Nguyen-Dinh,3 J.F. Naimoli,4 & J.G. Breman5
Evaluation is an essential management tool for the improvement of public health programmes or projects. As malaria morbidity and mortality continue to increase in most countries in Africa, international agencies and malaria control programmemanagers have identified the strengthening of programme evaluation as an important strategy for improving the efficiency and effectiveness of malaria control programmes. Managers can develop an evaluation strategy only after they have defined programme objectives and planned specific programme activities. Indicators should be directly related to programme objectives and should be selected on thebasis of the following criteria: their validity; reliability; ability to detect change within a reasonable time period and as a result of successful programme implementation; ability to be interpreted; and usefulness in guiding programme change. Only those indicators that can be measured with available programme resources should be selected. Managers will also need to identify the sources ofindicator data and to determine how often each indicator will be measured. Programme managers should develop criteria or indicators for the following: programme policies and plans; the process of programme implementation; the outcomes of malaria control interventions in disease management and prevention; and programme impact in terms of reductions in malaria-related mortality and morbidity. Key issuesrelated to the management of evaluation activities within a national programme include the need to begin with available resources and build incrementally; to explore options for administering evaluation activities; to select, train and supervise staff who carry out evaluation activities; to develop quality control strategies; and to ensure that data are managed and communicated in ways thatsupport effective programme decision-making. For evaluation to lead to improvements in malaria control programmes it must be clearly defined as a part of the programme management process. Programme managers should lead this developmental process, ensuring that evaluation methods produce the information they need to monitor and improve their programmes at reasonable cost.
* An earlier version of thispaper was presented at a meeting of the WHO Working Group on Malaria Control in the African Region, held on 15-18 March 1993, in Brazzaville, Congo. 1 Evaluation Specialist, International Health Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. Requests for reprints should be sent to Dr Bryce at the following address: Division of Diarrhoeal and Acute Respiratory DiseaseControl, World Health Organization, 1211 Geneva 27, Switzerland. 2 Formerly: Directeur de la Medecine Preventive et de la Lutte contre les grandes Endemies, Ministry of Health, Central African Republic. Currently: MPH Program, Johns Hopkins University, Baltimore, MD, USA. 3 Medical Officer, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers forDisease Control and Prevention, Atlanta, GA, USA. Reprint No. 5487
Inadequate implementation of control programmes has limited efforts to address an already serious malaria problem in Africa (1). In response to this, in
4 Health Education Specialist, International Health Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. 5 Formerly: Deputy Chief, MalariaBranch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Currently: Associate Director for Operations, National Vaccine Program, Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC, USA.
Bulletin of the World Health Organization, 1994, 72 (3): 371-381