Haiti malaria program; report of evaluation team, 5/20/79

Special evaluation covers the period 1978-5/79 and is based on document review and interviews with advisors and USAID/H and SNEM staff during site visits. Due to poor goal identification, lack of detailed action and budgeting plans, and the unknown feasibility of an eradication program, the project has not succeeded in reducing the incidence of malaria to targeted levels. Fenitrothion was sprayed in 453 localities of the coastal plain covering 28,414 houses and a population of 102,000. Malathion was sprayed in 23 localities of the drier hill area covering 2,040 houses and a population of 6,833. Thermal fogging was carried out in other areas. Larviciding with gasoil or temephos EC 50% was done in some mosquito breeding waters, while larvivorous fish were introduced as biological controls in other areas. Eight of 29 environmental management projects have been completed, ranging from simple drainage to large-scale water management; one spin-off has been the retrieval of land and water for agricultural use. In 1978, 167,093 radical treatments using chlorquine with primaquine were given to 42,606 malaria victims and to 118,487 household contacts. The surveillance system has experienced difficulties at all administrative levels. Lack of entomological and epidemiological baseline data leaves the impact of project activities uncertain. It is recommended that the use of the residual insecticides be arrested until their effectiveness is acertained by an epidemiologist in conjunction with an entymologist and a sanitarian and the most effective, least expensive insecticide is selected. Homogeneous eco-epidemiological strata should be identified throughout Haiti for field testing interventions. Replacements for departing advisory staff should be recruited and materials procured. SNEM staff should be trained to conduct anti-malarial programs, and responsibilities should be decentralized and coordinated. Vector source reduction should be continued through campaigns of environmental management and biological control while the drug distribution program is modified. Finally, project funding strictures should be reconsidered.