Malaria diagnosis and treatment activity (MDTA) : final performance evaluation

MDTA, implemented by ICAP at Columbia University and funded by the USAID/PMI, aimed to improve malaria diagnosis and treatment quality in Ethiopia. The evaluation used mixed methods, including interviews, desk reviews, and health facility surveys. Findings indicated that MDTA actively engaged in coordination at national levels, contributing to guideline development and slide bank establishment. Despite administrative challenges, collaborations with partners enhanced tool adaptation. At the regional level, MDTA revitalized technical working groups and organized joint supervisory meetings, supporting conflict-affected facilities, and supporting service resumption. A comprehensive mentorship program led to improved provider skills and reduced clinically diagnosed malaria cases. Health facility assessments showed substantial improvements in clinical and laboratory services, with enhanced networking and establishment of EQA centers under the RHB administration. Private sector engagement lacked uniformity, and while laboratory service scores improved at health posts, clinical service scores decreased. The country DHIS2 data, which is administered by MOH, indicated lower malaria deaths to admissions in MDTA-supported districts compared to national figures, but caution is advised in interpretation due to potential reporting completeness and geographic differences. A range of training programs on malaria and fever case management, laboratory diagnosis, and quality assurance were conducted, significantly improving data accuracy by reconciling malaria data from various sources. Distribution of comprehensive laboratory registers and malaria monitoring charts enhanced data quality and utilization at the facility level. MDTA faced challenges in sustaining progress at certain health facilities due to minimal support and resource constraints from government entities, alongside staff turnover and stock-outs. Nevertheless, the activity significantly improved the quality of malaria diagnosis and treatment at health facilities. Integration of malaria services into ANC clinics was supported, along with collaborations with RHBs for mentorship and training. MDTA contributed to national guidelines, EQA programs, and established E learning platforms. Sustainability potential was identified in various areas, including RHBs for supervision, regional laboratories for EQA activities, and Woreda Health Offices for supportive supervision. Despite challenges, hospitals, health centers, and health posts were expected to sustain some activities/results of MDTA support for a while. Operational challenges such as conflict, COVID-19, funding cuts, and procurement delays affected MDTA"s ability to achieve its objectives. These challenges led to interruptions in activities and shortage of essential commodities. MDTA addressed national malaria case management system needs through joint planning, capacity-building, and targeted interventions for vulnerable populations. Despite the lack of systematic gender-specific and private-sector efforts, key takeaways include resource optimization via malaria and TB EQA integration, equipment maintenance, virtual mentorship during crises, data accuracy empowerment for health workers, and fever case management integration into ANC/PNC services.