Interpreting malaria control program evaluations

About a year and a half ago I briefly discussed a WHO report (see comments here) claiming the success of scale-up of malaria control interventions. Now a group of CDC/ex-CDC scientists have published a superb commentary (Malaria Journal – open access) on the same evaluation and on using facility-based data more broadly (hat tip: Matt Price). The authors focus on technical pitfalls, which were aplenty, but these are often exacerbated by the incentives of the evaluators. In act of terrific political deftness, Rowe et al. avoid any discussion of possible conflicts of interest.

On an unrelated note, I found the first sentence of the abstract to be curiously phrased:

The global health community is interested in the health impact of the billions of dollars invested to fight malaria in Africa.

First,  the prima facie concern regarding the impact of malaria control is with endemic countries. They have skin in the game. It is unclear what “the global health community” really means – while it could be inclusive of endemic nations the connation of the phrase seems more aligned with a donor perspective. Thus, the rationale of this paper reads “accurate program evaluations are needed because donors want to assess their impact.” This is wrong. Quality evaluations are important first and foremost because they allow country programs to track and improve their progress in minimizing the suffering of their citizens.  Anything else is secondary and subjugate to this concern. The framing of the sentence reflects a subtle, and likely unintentional, appropriation of responsibility which may not impact practice but devalues local decision makers. Second, why “in Africa”? Neither malaria, large investments, nor the cautions highlighted in the commentary are specific to that continent.


2 Responses to “Interpreting malaria control program evaluations”

  1. 1 barmak September 6, 2009 at 9:00 pm

    Good points, naman. I browsed this article last week. Will have to read more closely.

  2. 2 naman September 7, 2009 at 9:42 am

    thanks Barmak – I enjoyed the paper

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