RBM Monitoring and Evaluation Reference Group MERG John Miller WHO Roll Back Malaria Department Moni

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RBM Monitoring and Evaluation Reference Group
(MERG) John MillerWHORoll Back Malaria
DepartmentMonitoring and Evaluation
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Overview

• RBM Monitoring and Evaluation Reference Group
  (MERG)
• MERG Task Forces, Progress Products
• http//rbm.who.int/merg
• Malaria monitoring and reporting
• Global Malaria Report 2004

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Monitoring and Evaluation Reference Group (MERG)

• Acts as advisory body to RBM
• Technical focus on global indicators to ensure
  consistency
• Maintains communication with ROs on process
  monitoring and country-specific ME issues but
  does not address these issues as part of its
  primary mandate
• Geographic focus on Africa
• Functions
• Technical guidance on selection and definition of
  indicators for national, inter-country and global
  reporting
• Advising on prioritization of tasks and
  recommendations on appropriate data collection
  methods, analysis and dissemination of
  recommendations
• Identifying critical technical questions on ME
  and organizing smaller task forces to address
  these
• Monitoring changing ME needs as country
  programmes and the RBM initiative itself, mature
• Supporting coordination of ME activities among
  other RBM working groups and partners
• Identifying and recommending strategies for
  addressing capacity building needs at all levels

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Monitoring and Evaluation Reference Group (MERG)

• First meeting in Arlington, VA, USA, May 2003
• Chairs WHO and UNICEF Secretariat MACRO
• includes representatives from RBM partners,
  Regional Offices (UNICEF and WHO) and experts
• assists with technical consensus on selection of
  indicators, standardization, and clear guidelines
  for data collection/ sampling
• with Task Forces
• mortality (chair UNICEF, first meeting July
  2003)
• morbidity (chair WHO, first meeting Oct 2004)
• anemia (chair WHO, first meeting Oct 2003)
• survey tools (chair Macro DHS, first meeting Feb
  2004)
• ME capacity building in countries (chair
  Malaria Consortium)
• Second meeting held in Kampala, Nov 2003
• Third meeting held in Geneva, May 2004
• Fourth meeting currently underway in New York
  City, 15-16 November 2004

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MERG Mortality Task Force

• First meeting, UNICEF HQ, New York City July 16,
  2003
• Focus on monitoring of mortality impact of
  malaria control among African children
• Recommendations
• Primary impact indicator should be all-cause
  child mortality as measured by household surveys
• e.g. typical DHS of 7,000 women would enable
  statistically significant detection of child
  all-cause mortality reduction of 15 or more
• VA, HIS data on malaria mortality and VR tends
  to underestimate impact of malaria control
• Greater emphasis must be placed on coverage
  indicators before embarking on impact measurement
  
• Given current coverage levels and rates of
  increase in coverage, annual reporting on
  mortality (other than deaths occurring in health
  facilities) is not realistic
• Impact on malaria-specific mortality may be
  estimated from measured trends in all-cause
  under-5 mortality rate in combination with
  measured coverage of the three key interventions
• Collaboration with CHERG and CDC to review
  published literature and develop baseline 2000
  estimates of malaria deaths among African
  children

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MERG Anaemia Task Force

• Meeting 27-28 October 2003, Geneva
• Data from malaria intervention trials support the
  use of childhood anaemia as an indicator of
  malaria burden and RBM impact in areas of stable
  malaria transmission
• Childhood anaemia is best monitored through
  childhood surveys
• More timely and smaller sample size required than
  all-cause mortality
• Should be measured as Hb level, using Haemocue,
  in children aged 6-59 months
• Surveys should ideally be conducted during or
  immediately after the rainy season for impact
  measurement an interval of 2 years (range 1-5
  years) is optimal
• Key indicator is Hblt8 gm/dl
• Outstanding issues
• Additional measurements, such as (sentinel)
  clinical surveillance
• Anaemia in pregnant women as supplementary
  indicator
• For most endemic settings, limitation of analysis
  to 6-24 month age group
• How to interpret trends in anaemia in view of
  confounders such as malnutrition, HIV/AIDS,
  geohelminths, etc
• Use of anaemia as indicator in areas of unstable
  and low malaria endemicity
• Value of child/adult anaemia ratios instead of
  absolute anaemia prevalence as indicator of
  malaria burden

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MERG Survey Task Force

• Meeting 10-11 February 2004, Calverton MD, USA
• Timely because
• UNICEF in process of revising the MICS survey for
  the next round. The next round of MICS will
  include the full MIS package of questions for
  children under 5 in relevant countries
• GFATM funds beginning to flow to countries WHO
  and UNICEF being approached for advice We get
  many requests for standard methods!!
• Products
• Malaria Indicator Survey (MIS) Package for
  household level coverage assessments
• Stand-alone survey with focus on core coverage
  indicators
• Also available as scaled-down "add-on" module
• Package includes
• Questionnaires (Household and womens)
• Rationale for each question
• Interviewer's and Training manual
• Guidelines on Core Malaria Indicator (available
  as HANDOUT)
• Guidelines on sample design and size estimations
  (long and short versions)
• Data tabulation plan
• CSPro data management tool
• Guidelines to programme managers on use of package

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MERG Morbidity Task Force

• Meeting held Oct 2004 to review draft methods and
  country-level estimates
• Incorporates existing (MARA for Africa) and new
  (for outside of Africa) population at risk
  estimates, population denominators (GPW 3, GRUMP)
  and standard UN population age distributions
• Applies fixed incidence rates by endemicity, age,
  and location (geographic and urban/rural)
• Includes work of Child Health Epidemiology
  Reference Group (CHERG) and LSHTM on malaria
  morbidity estimates in African children
• Estimates adjusted for coverage of interventions
  and reported HMIS where relevant
• Large uncertainty with sensitivity analyses and
  most estimates are very imprecise
• Task Force recommendations are being implemented
  and Task Force members are contributing to a next
  version.
• Triangulation of estimates with WHO Global Burden
  of Disease project

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MERG Capacity Development Task Force

• Purpose Prepare a conceptual framework for
  strengthening monitoring and evaluation capacity
  at country and subregional levels
• Status
• Awaiting funding to conduct needs assessment
• Subcontract signed with MACRO in March 2004
• Work scheduled for May-August 2004
• Review approaches and agree on methodology
• Review existing ME documentation
• AFRO ME Mission reports, 2003
• Reaping reports, 2003/2004
• Series of rapid country assessments (three)
• Draft framework
• Workshop in Harare
• July/August 2004
• AFRO, MC, MACRO (and other interested partners)
• Review findings and discuss draft framework
• Finalise and present to MERG in November 2004

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Monitoring and Reporting Efforts for ME

• Examples
• Africa Malaria Report 2003
• 1st Abuja Summit Progress Report 2004
• Global Malaria Report 2004
• Intensified regional office and country feedback
  via standard country profiles (examples as
  HANDOUTS)

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Questions or comments

• Please see the MERG site
• http//rbm.who.int/merg

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Basic Malaria ME Framework

• Input Process Outputs
  Outcomes Impact

• Service delivery
• knowledge, skills, practice

• disease burden
• Socio-economic wellbeing

• strategies
• policies
• guidelines
• financing

• human resources
• training
• commodities

• coverage
• behavior change

Information available and standard indicators

• U5 fever treatment with antimalarials
• HH ITN possession
• ITN use
• PW use of IPT/chemoprophyl-axis

• Volumes of insecticides used for malaria vector
  control (WHOPES)

• Financial resources
• Drug policy
• Strategies

• Trainings (EMRO)

• Insecticides used for malaria vector control
  (WHOPES)
• Drug and insecticide resistance/efficacy
• Nets/ITNs sold or distributed
• Nets (re-) treated
• Antimalarial drugs distributed/used

• Malaria morbidity mortality (WHO HQ RO
  standard case definitions)
• All-cause U5 mortality
• Anemia (?)