Malaria control in complex emergencies: the example of East Timor.

Malaria control in complex emergencies forms part of the World Health Organization's Roll Back Malaria (RBM) initiative. The underlying principle is a partnership with other UN agencies and non-governmental organizations, with the RBM programme providing support to its implementing partners through a Technical Support Network. This innovative approach was applied for the first time in 1999-2000, following the return of stability and security to East Timor. The RBM programme assessed the malaria situation during the acute emergency phase and identified programme priorities. Two non-governmental organizations were subsequently invited to operate as implementing partners. Individual proposals were developed and funding obtained, but no overall organizational and planning framework was established. Implementation commenced quickly, addressing aspects of prevention, diagnosis and treatment. As East Timor progressed into the transitional phase towards independence, the programme was not realigned to the changing context. Absence of monitoring and evaluation was a significant factor contributing to the resulting continuation of emergency malaria control activities well into the transitional phase. East Timor's example of malaria control in complex emergencies provides important lessons: (i). partnership roles and responsibilities should be clearly defined from the beginning of the programme, (ii). planning, monitoring and evaluation should be instigated from the start with the aim to develop long-term strategies and policies, (iii). expert support is necessary to guide implementation at all stages, (iv). the flexibility to react to changing priorities should be ensured as the context of the emergency and the available health structure changes, and (v). the implementation process, and alternatives for continuation of activities once the RBM complex emergency partnership has terminated, should be clarified to all partners involved.