Diagnostic capacity and antimalarial availability in Papua New Guinea before the introduction of a revised national malaria treatment protocol

@#BACKGROUND: Papua New Guinea (PNG) introduced a revised national malaria treatment protocol (NMTP) in late 2011. Successful implementation of the revised protocol requires all health facilities in PNG to have reliable access to microscopy or malaria rapid diagnostic kits as well as a reliable supply of all recommended first-line medications. This paper presents findings from a study that sought to assess the availability of microscopy, malaria rapid diagnostic kits and recommended first-line antimalarial medication in Papua New Guinean health facilities across the country before the introduction of the revised treatment protocol. METHODS: A country-wide cross-sectional survey of 79 randomly selected health centres, health subcentres and aid posts. Data were collected via an interviewer-administered questionnaire completed with the officer in charge of participating health facilities. RESULTS: Overall, 15% of surveyed health facilities had unexpired rapid diagnostic test (RDT) in stock or working microscopy available. A recommended first-line antimalarial for uncomplicated malaria was available in 85% of health facilities. The preferred first-line antimalarial combination for treating severe malaria was present in 42% of health facilities, although 68% had the capacity to provide either the preferred or recommended substitute first-line medication for severe malaria. The total number of health workers employed in the 79 surveyed health facilities was 443, only 3 of whom were medical doctors. CONCLUSIONS: Our findings indicate that diagnostic capacity was low in Papua New Guinean health facilities before the introduction of the new NMTP and that access to recommended first-line antimalarial medication was variable. Substantial improvements in diagnostic capacity and antimalarial procurement and distribution will need to be made if the revised protocol is to be adhered to.

Evaluation of the Global Fund-supported National Malaria Control Program in Papua New Guinea, 2009-2014

@#The Global Fund to Fight AIDS, Tuberculosis and Malaria is the major funaer of the National Malaria Control Program in Papua New Guinea (PNG). One of the requirements of a Global Fund grant is the regular and accurate reporting of program outcomes and impact. Under-performance as well as failure to report can result in reduction or discontinuation of program funding. While national information systems should be in a position to provide accurate and comprehensive information for program evaluation, systems in developing countries are often insufficient. This paper describes the five-year plan for the evaluation of the Global Fund Round 8 malaria grant to PNG (2009-2014) developed by the Papua New Guinea Institute of Medical Research (PNGIMR). It builds on a complementary set of studies including national surveys and sentinel site surveillance for the assessment of program outcomes and impact. The PNGIMR evaluation plan is an integral part of the Global Fund grant. The evaluation program assesses intervention coverage (at individual, household and health facility levels), antimalarial drug efficacy, indicators of malaria transmission and morbidity (prevalence, incidence), and all-cause mortality. Operational research studies generate complementary information for improving the control program. Through the evaluation, PNGIMR provides scientific expertise to the PNG National Malaria Control Program and contributes to building local capacity in monitoring and evaluation. While a better integration of evaluation activities into routine systems would be desirable, it is unlikely that sufficient capacity for data analysis and reporting could be established at the National Department of Health (NDoH) within a short period of time. Long-term approaches should aim at strengthening the national health information system and building sufficient capacity at NDoH for routine analysis and reporting, while more complex scientific tasks can be supported by the PNGIMR as the de facto research arm of NDoH.