Developing a theory of change model to re-orient malaria screening programme during the prevention of re-introduction phase in Sri Lanka

Abstract

Background: Sri Lanka is the first major tropical country certified by WHO as malaria free during the past three decades. High malariogenic potential within the country makes this achievement extremely fragile. WHO recommends to re-orient the malaria programme following elimination. Theory of Change (ToC) is effective in developing, Implementing and evaluating complex public health interventions. This paper represents a part of a broad study to evaluate the effectiveness of an intervention package designed to achieve desired programme changes of re-orientation and describes framework developed based on ToC.

Methods: The impact and the long-term outcomes expected to see in a re-oriented malaria programme were identified in consultation with two experts in the field of malaria and ToC, and review of relevant literature. Two consultative meetings held with stakeholders to develop the ToC, including six regional malaria officers, five experts from the national malaria programme and technical support group of the programme. The desired long-term outcomes, interventions and the target groups and the content of the interventions were decided. Available resources and feasibility of implementation were discussed, and major assumptionswere recorded. The indicators to evaluate the processes and outcomes were decided.

Results: A ToC model was developed to achieve re-orientation of malaria screening. This was used to identify areas that need changes in order to achieve expected programme change, to develop specific interventions targeting relevant groups to bring about the desired programme change, and to identify indicators to evaluate the same.
Conclusions and recommendations: This model was successfully used as the basis of designing, implementing and evaluating an intervention package to achieve re-orientation of malaria screening.
Acknowledgement: National Science Foundation, National Health Research Council.