(i) Please can we spend 10% of budgets implementing, sustaining, reading and acting upon valid M&E.

(ii) Can our valid M&E be based on outcomes and impact, and not coverage of drugs/bednets supplied.

(iii) Ditto April’s points above.

Steve.

http://philanthropy.com/giveandtake/index.php?id=915

This study seems to indicate the promise of a combination of interior spraying and treatment: Impact of DDT re-introduction on malaria transmission in KwaZulu-Natal

“These numbers themselves are not very reliable, and we know that a bednet handed out is a long way from a bednet being slept under when mosquitoes are out. Ditto for drugs. Yet – the global community plows onward blindly.”

…is key. Anyone who has lived in Sub-Saharan Africa knows that the battle is not supplying adequate nets, but rather ensuring that nets are used correctly. Too often, bednets are turned into fishnets, wedding dresses (seriously – wedding dresses), etc.

It always amazes me to hear activists and fundraisers in the US imply that malaria problems could be resolved if only development actors would supply enough nets. Perhaps because measuring net distribution is easier than measuring the accompanying behavior change or (as detailed above at length) measuring impact on incidence rates?

http://www.portfolio.com/views/blogs/market-movers/2009/02/12/malaria-easterly-vs-gates?tid=true

I know someone who was treated as a child by an older remedy in one bout with malaria (believe it or not, many people get malaria several times and don’t die! I myself have survived malaria as a child). This person felt better the same day and was well the next day – after having been practically bedridden. The knowledge of the herbs/etc used for the treatment is lost, though. From my experience in West Africa, I saw generic malaria meds everywhere – from the big cities to the villages. I didn’t see/hear of people taking them regularly.

http://femmeautonome.blogspot.com/search/label/malaria

You’ve hit a very important nail on the head.

The information about program implementation and impact which is collected and used in malaria programs is terrible: almost all of it comes from program reports of drugs or nets distributed, and/ or similar numbers from the information systems for public facilities. These numbers themselves are not very reliable, and we know that a bednet handed out is a long way from a bednet being slept under when mosquitoes are out. Ditto for drugs. Yet – the global community plows onward blindly. My friend Benjamin Loevinsohn asked me recently if we’d ever get tired of “bowling in the dark”. It occurs to me that we may prefer it, because then we can always just say that we are succeeding…with no info to contradict us.

Two actions which the Gates’ and other donors could contribute to, which would really make a difference are:

1) to move to doing household surveys every 2 years, rather than every 5. This would be frequent enough to give us much more insight into which progam interventions are really making a difference; and,

2) START (for the first time, believe it or not) conducting yearly facility surveys to find out what is happening at that level.

These initiatives would cost a fraction of the money that is wasted by continuing to use program approaches that aren’t working.

Thanks again for drawing attention to this critical, and all too often overlooked, issue.

Great post, great blog. I just got back from Kenya where there has been massive net distribution and similar claims of reduction of millions of malaria cases saved. Unfortunately, I discovered that providers almost never actually test for malaria and lab capacity is abysmal. Probably 90% of fevers are reported as a malaria case. It would take a massive survey involving blood sampling to get a reliable estimate of the reduction of malaria and considerable investment would have to be made in building the countries diagnostic capacity to do it.

The offending article is here – http://www.afro.who.int/note_press/2008/pr20081905.html

Roger and I and others protested to the WHO; we never had any response to these letters, e.g. – http://fightingmalaria.org/pdfs/WHOAFRO_Press_Release.pdf

Thanks

Richard