Departmental audit of malaria control programme 2001-2005 north west frontier province (NWFP).

BACKGROUND: Pakistan adopted the malaria control strategy with provincial commitment in 1998. Pakistan joined the Roll Back Malaria (RBM) initiative in 2001. This led to development of a 5 year roll back malaria strategy. The aim of the paper is to audit whether the malaria control programme in NWFP was able to implement strategies suggested by RBM initiative in the year 2002-2005, and its subsequent effect on the number of cases of malaria confirmed by peripheral blood smear/slide (confirmed cases), confirmed cases of plasmodium Falciparum (P. Falciparum) and annual parasite incidence (API).
METHODS: Data was obtained from the malaria control programme (MCP), directorate general health services, Peshawar. We examined budget allocation and its breakdown for financial years 2002-2005 and standard surveillance proformae (data sheets) containing summated data. Data had been totalled from all first level care public health facilities (outpatient facilities) in 24 districts for 2001-2005. This was further totalled by the malaria control programme to give annual figures for the entire province. The data from the province contained information on, the total no of slides examined by active case detection, (ACD) passive case detection, (PCD) cases of malaria confirmed by peripheral blood slide examination, total number of cases of plasmodium Falciparum (API) confirmed by peripheral blood slide examination and annual parasite incidence (API) for 2001-2005.
RESULTS: budget allocation fell from rupees 5.043 million in 2002 to rupees 3.3 million in 2005. In 2002 malaria control programme purchased 400,000 blood lancets and 437 kg more insecticide than the consecutive years, but all other items purchased were the same. By the end of 2005, 925 medical officers and 67 microscopists had been trained in case management and diagnostic techniques (according to who guidelines) in 16 districts of NWFP in a phased manner. Budget for training was not allocated from the provincial malaria control programme. The total number of slides examined in 2005 was 62% more than 2001. the number of slides collected by active case detection increased by 68% and passive case detection increased by 55.7% from 2001 to 2005. Total number of malaria cases confirmed by peripheral blood smear peaked in 2002 and 2003 and then fell in 2004. In 2005, the number of malaria cases confirmed by peripheral blood smears were similar to those reported in 2001. Annual parasite incidence (API) peaked in 2002 and 2003 to 3.01 and 3.57 per 1000 respectively, it fell in 2004 and in 2005. API was reported to be 2.01 per 1000 in 2005, this was double the rate reported in 2001, i.e., 1.09 per 1000. The confirmed cases of plasmodium Falciparum peaked in 2002 and 2003, the number of cases decreased in 2004, and by 2005, the number of cases reported were similar to 2001.
CONCLUSION: NWFP was committed to roll back malaria initiative but it appears that it was unable to implement the strategy, because of the lack of a parallel commitment in resources. Although annual figures illustrate activity in the malaria control programme, inferences have not been drawn from the data. There is no evidence to suggest that information is disseminated or any feedback is given to the districts and the first level health care facilities. The malaria control programme does not appear to have capacity or resources to change policy or implement change based on evidence depicted by the data.