The evaluation of malaria control operations implemented by 43 provincial offices supported by The Global Fund to Fight AIDS, TB, Malaria (GFATM) Round 7: Impact and policy evaluation

Abstract

Malaria remains the major public health problem in Thailand, especially along the international borders. Cross border movement of migrant workers and political conflicts in the South result in uncontrolled spread of the disease. To solve the problem, the project of partnership towards malaria reduction in migrant and conflict-affected population in Thailand supported by The Global Fund to Fight AIDS, TB, and Malaria Round 7 has been implemented in 43 malaria endemic provinces since 2008. Thai impact evaluation study aims to assess the impact of the aforementioned project and derive lessons to further improve the implementation of the second phase. Information for evaluation includes both primary and secondary data. Epidemiological information gathered from the national malaria surveillance system. Random sampling surveys were conducted to measure behavioral changes including malaria knowledge, perception, and practice. Satisfactory survey was performed to assess satisfactory to newly established malaria posts. The results indicated that the project has contributed to the reduction of malaria mortality rate, malaria incidence rate, source of infection and positive rate among foreigners who reside in Thailand less than 6 months. However, the malaria incidence rate and positive rate among migrants do not reach the project target suggesting the implementing strategies should be critically revised to effectively reach vulnerable population. Outcome evaluation indicates improvement of behavioral changes, but do not reach project targets. By 2010, more than 58% of household in endemic areas are covered by insecticide treated nets (ITN) and nearly half (47.4%) of risk population slept under ITN at the previous night. An estimate of 40% of malaria patients living in endemic area received anti-malaria treatment according to national policy within 24 hrs of onset of fever. In addition, more than half of vulnerable populations living in malaria transmission malaria areas have well malaria knowledge and perception. In conclusion, the project should revise implementing activities in the second phase to effectively reach target populations, especially in low transmission areas (A2). ITN distribution should be well manage to cover vulnerable people and effective behavioral change combination strategies are urgently developed due to behavioral change indicators partially improve.