Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence

Area of Science:

• Epidemiology
• Public Health
• Malaria Control

Background:

• Malaria interventions have reduced transmission, leading to more focalized and heterogeneous patterns.
• Evaluating malaria programs in low, moderate, and heterogeneous transmission settings presents unique challenges.
• Existing evaluation guidance often focuses on high-transmission settings.

Purpose of the Study:

• To provide a framework for designing and conducting malaria program evaluations in low, moderate, and heterogeneous transmission settings.
• To offer guidance on answering context-specific evaluation questions.
• To support programmatic decision-making in diverse malaria transmission scenarios.

Main Methods:

• Development of a framework by a task force from the Roll Back Malaria Monitoring and Evaluation Reference Group.
• Building upon existing guidance for process, outcome, and impact evaluations.
• Incorporating considerations for evaluation design, including transmission setting, stratification, and data availability.

Main Results:

• Confirmed malaria incidence is recommended as a sensitive primary impact indicator for low-transmission settings.
• Process evaluations are crucial for program monitoring and improvement.
• Impact evaluations, often using plausibility designs (e.g., interrupted time series, dose-response analyses), are needed for new interventions or changing epidemiology.
• Triangulating multiple data sources strengthens evaluation plausibility.

Conclusions:

• The framework provides a structure for designing malaria program evaluations in diverse transmission settings.
• It emphasizes a continuous cycle from process to impact evaluation, informing programmatic decisions.
• Practical guidance is offered for evaluation design, analysis, and interpretation to meet national program priorities.