Measuring the Impact of Malaria Interventions in the DRC
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 treatment for pregnant women (IPTp).
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 the 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 MEASURE Evaluation’s resident advisor in the DRC since 2013, recently helped launch an evaluation in that country. “This is the first malaria impact evaluation under the National Malaria Control Program (NMCP),” he says. “The results will be important, because they should help determine whether the funds contributed to malaria control programs in the DRC have had a positive effect on health outcomes.”
The evaluation will combine and triangulate existing data from several sources to determine whether the interventions have affected outcomes. This includes the use of existing data to create a counterfactual of what those outcomes may have been in the absence of the interventions.
Setting the Stage
Before data collation, compilation, and analysis could begin, evaluators first had to obtain stakeholder buy-in and design the study. In January 2016, with support from MEASURE Evaluation staff from ICF International in the United States, Kakesa began meetings with stakeholders.
“We met with colleagues from the United States Agency for International Development (USAID), PMI, and the NMCP to define our data sources and agree upon the purpose and structure of the project,” he says.
In May 2016, 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. Later in the year, they received final approval of the protocol and began work on the evaluation.
Collating and 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 the DRC.
“We already have reason to believe that mortality for children under 5 is decreasing,” says Kakesa, referring to the 2014 Demographic and Health Survey that showed the all-cause child mortality for that demographic had fallen from 148 under-5 deaths per 1,000 in 2007 to 104 under-5 deaths per 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 symptoms of malaria are similar to symptoms of other common childhood diseases, and also because most death occurs outside the healthcare system without appropriate diagnosis. But in countries with high malaria burden, such as the DRC, malaria is a key contributor to all-cause child mortality. 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 Kakesa. “All the data used in this study will meet or exceed our predefined minimum quality standards.”
Kakesa hopes the evaluation findings will be published by the end of 2016, 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.”