Report of the evaluation of the USAID Zanzibar malaria control project

Special evaluation covers the period 9/81-10/83 and is based on document review, site visits, and interviews with Government of Zanzibar (GOZ) and project staff. The project is two years behind schedule due to: the delayed arrival of the project manager (in 5/83); the slow recruitment of MCP staff; and the lack of a full-time health educator and of GOZ-approved annual/long-term work plans. However, some progress has been made. A number of AID-supplied commodities have been received (e.g., land rovers, trucks, and lab, office, and audiovisual equipment); insecticides (DDT, Malathion) and antimalarial drugs have been ordered. Also, 49 of a targeted 83 malaria agents (MA's) and supervisors have been hired; 41 MA's have attended three workshops in registration techniques, blood-slide preparation, and chloroquine use/dosage. Supervisory staff have participated in an observation tour of Sudan and two international health conferences, and eight microscopists have received inservice training. However, only one of five Master's degree candidates in public health has begun U.S. study, planned training materials have not been prepared, and health education has been limited to the preparation of radio/television spots and to giving malaria prevention lectures to school children. Although MA's only began active case detection activities in 11/83, their performance so far has been satisfactory. Most health centers/rural dispensaries have adequate antimalarial drug supplies; however, only one of nine health centers visited was properly administering chloroquine to malaria patients. Spraying operations have been limited to larviciding with only marginal effect; the planned 3/84 spray may be hampered by delays in procuring insecticides and training spray personnel and by inadequate planning/equipment. The project entomologist has conducted limited susceptibility tests on Anopheles gambiae and prepared an entomology work plan. Key recommendations are to revise the project's implementation schedule and targets, especially in view of widespread parasite resistance to chloroquine and increasing signs of DDT-resistance by the vector mosquito.