Malaria control II project, no. 391-0427, external evaluation 1984-part I : evaluation of feasibility of using voluntary collaborations for malaria case detection and treatment

Special evaluation covers the period 5/82-5/84 and is based on site visits and interviews with VC's, malaria supervisors (MS), and other project personnel and beneficiaries. Although PCD posts have been activated in three of the four districts (Lahore, Bannu, and Larkana), the project is barely underway; the number of VC's selected and trained so far is very small and only in Bannu have VC's been functioning longer than a month. This may explain the project's weaknesses to date. Because of the purdah system, nearly all of the few VC's selected have been men, and most of these have been schoolteachers or unqualified health care dispensers. Although the trainees are enthusiastic, the training itself has been poor; most of the VC's interviewed were unclear about their duties, the correct presumptive dosage of chloroquine, or the proper procedure for making bloodsmears. Further, many lack the materials (e.g., patient report forms) needed to carry out their duties and no provisions have been made for VC's to administer radical treatments to patients with positive bloodsmears. In addition, MS's supervision of VC's in the field appears lackluster and ineffective, as do MS's ongoing Active Case Detection (ACD) activities. A lack of equipment and transportation, enthusiasm, discipline, and a sense of responsibility are common problems among MCP workers. Also constraining success of the PCD program are negative attitudes by both non-MCP medical workers/technicians (who do not consider malaria their responsibility) and of MCP personnel (who doubt the efficacy of PCD and the use of VC). If the above problems can be overcome, establishment of an effective VC network for PCD is clearly feasible. Major recommendations include increasing the number of VC and standardizing guidelines for their selection, training, and supervision; making ACD/PCD complementary; enforcing MCP work codes; providing incentives for MS's and VC's; and increasing training for all MCP personnel.