This how-to guide was developed to support professionals from National Malaria Control Programs (NMCPs), health promotion units, technical working groups, and implementing partners to monitor and evaluate social and behaviour change communication (SBCC) activities that support case management. As explained in the toolkit, "case management of malaria has changed a great deal since the introduction and widespread use of rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT). These changes demand shifts in the way individuals, households, communities, and service providers think about malaria case management. Prompt care seeking for fever continues to be emphasized by SBCC campaigns, but families are now being asked to demand for a test before seeking medication. Service providers are being asked to replace clinical diagnosis of febrile patients with blood testing. While supply-side factors such as RDT and ACT availability play a definite role in uptake and use of these essential commodities, efforts to eliminate stock-outs should be paired with activities that establish trust in RDT reliability (response efficacy) among providers and in communities."
The guidance in this Kit is aligned with World Health Organization (WHO) Test, Treat, Track (T3) guidance on malaria case management:
- Every suspected malaria case should be tested.
- Every confirmed case should be treated with a quality-assured antimalarial medicine.
- Every malaria case should be tracked in a surveillance system.
The guide takes the reader through five steps in developing and executing a plan for monitoring and evaluating (M&E) SBCC components of malaria case management interventions. These three components are:
- Recognition of malaria signs and symptoms and prompt care seeking at the community level for febrile children under 5 - Prompt care seeking at the community level remains the cornerstone of malaria case management. Guidance on measuring this intervention's impact is most likely to serve the greatest number of SBCC practitioners.
- Demand generation for testing before treatment among parents and guardians of children under 5 - The increased emphasis on testing before treatment requires SBCC programmes to improve the communities’ desire for and acceptance of RDTs, so that demand matches supply and available RDTs. The section of the guide describes how to measure increased demand for proper diagnosis before treatment.
- Provider adherence to national diagnosis guidelines (regarding treatment according to test results) - High levels of adherence to diagnosis and treatment guidelines will ensure ACTs are more readily accessible, and used on only those who require them. To assist those working to improve compliance with national guidelines, the third focus of this guide explores a means of measuring service provider attitudes and behaviours.
The guide takes the reader through the following steps to address the above components of case management:
- Identify and Prioritize Behavioral Problems - Formative research should help both prioritise which behaviours to address, and determine likely means of addressing them.
- Select a Theory-Based Framework - The next steps to developing an M&E plan include choosing a theory-based behavioural model and an M&E framework.
- Consider Case Management-Specific Factors - The third step is deciding on the technical aspects of your M&E plan.
- Data Collection - Determine what mix of qualitative and quantitative data is appropriate and decide how to obtain each.
- Prepare, analyse and report data - Specify how data will be analysed and which indicators to include in reports.
Three examples based on actual SBCC programmes in sub Saharan Africa are provided. Each example gives a common scenario related to one of the three components of malaria case management outlined above, steps for monitoring or evaluating in that specific situation, and an example of an actual programme that faced those specific challenges. The examples and case study projects are as follows:
- Example 1: Improve Prompt-Care Seeking for Fever - The STOP Malaria Uganda project.
- Example 2: Increase Demand for Testing Before Treatment - STOP Malaria Community Champions initiative in Zambia.
- Example 3: Improving Facility-Based Service Provider Compliance with RDT Guidelines - Population Services International-implemented Mobilize Against Malaria (Kenya).