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TO SEE DISTRIBUTION ,, from ASIA/TR/PHN, David Ooi SUBJECT December3.. 194 M E MO R A N D U M TO SEE DISTRIBUTION ,, FROM ASIA/TR/PHN, David Ooi SUBJECT: Indonesia Malaria Project Evaluation Tem Debriefing Ea bmi1h. member of the evaluation team which recentlIvisi recntYlslted..Indonesia, will give a debrief nq on the teamt s findings on December I, 1984 at 2:00 p.m. in Room 3318, NS. (ASIA/PD Conference Room). A summary of the recommendations is attached for your informatlin. Attachment: a/s DISTRIBUTION ASIA/TR/PHN, Staff ASIA/TR, B. S'idman ASIA/EA/ISP, V. Molldrem ST/HEA, J. Erickson ST/HEA, L. Cowper DAA/ASIA, E. Staples ASIA/DP, M. Norton ASIA/DP, S. Pines MID-TERM EVALUATION OF'TIMOR MALARIA CONTROL PROGRAMME October - November, 1984 EXECUTIVE SUMMARY In general, malaria prevalance has gone down appreciably areas which have been under in those house spraying, however, the the following as major constraints team identified impeding progress towards achieving the project objectives: 1. The difficulty of recruiting and retaining adequate carry out the personnel to program in East Timor, but recognized has already made considerable that West Timor progress in overcoming this constraint. 2. The delayed release of funds which is having slowing a serious impact by down the progressive reduction of malaria and in some cases resulting in an increase of malaria. 3. The lack of the kind of entomological information necessary for planning and evaluating the program. 4. The lack of an adequate number of motor vehicles or the non-availability of malaria vehicles for field use when needed. The team report gives specific recommendations constraints for coping with these and also recommendations on examination up-grading the quality of the of the malaria slides, the development plan for both of an overall training East and West Timor, the assignment experienced of a well-qualified and malariologist to provide technical and West assistance to both East Timor, particularly in the area consideration of training, and proposes by USAID and GOI of a re-constituted with goals Timor Malaria Project and objectives revised on a realistic performance basis in light of and results obtained so far. It is the opinion of the team that a realistically extended for 2 to 3 revised project years and taking into account the made in this report recommendations would be able to achieve the project in terms objectives of the of reduction of malaria and population However, the team also feels covered. that the project objectives should considered in light of experience now be to date. It may well be that more malaria than was envisaged there is prepared at the time the project paper was and that restricting the project respectively coverage to the 40% and 30% of the population in East Timor and West Timor could lead to a quick return to the former hyper- malariometric and holo-endemicity. More surveys are needed as a basis for planning a revised and extended project. 6. IMPORTANT CONSTRAINTS IMPEDING PROGRESS TOWARDS ACHIEVING PROJECT OBJECTIVE...S 6.1. Delayed release of funds The most important constraint to the both East and West Timor success of the project malarlometric is the postponement in surveys due of spray oprations present to delays in the release and time there is a serious of funds. At the and problem in that funds malarlometric surveys for the spray cycle September-October which should have been 1984, are conducted in uot yet available for of the middle of November use in the program as accomplished until 1984, which means that late December 8 4/January the spraying cannot 1985, well after be the rainy season. the start of The delays are apparently due in information (account part to the fact that Headquarters records) sent from the is often improperly field to the Provincial corrections. prepared and muat However, in be returned for Dili several a meeting with the Regency individuals pointed Health Officers in the required out that they had difficulty information due to lack preparing lack of a typist of a typewriter in in another case and one case, the just plain lack of cases. time in other The team further feels that this is a progress in the control very jerious constraint of Malaria in Timor and that large part on finding will be dependent in a solution to this problem. 6.2. Personnel Problems The difficulty of recruiting, number of local personnel training and retaining particularly Is a constraint In an adequate acute problem all of Timor, but is education in East Timor. Due a of most of the local to the low level of is difficult population and to recruit and the low rate of literacy in train an adequate number it all categories. Although, of temporary workers that East West Timor is better Timor, it has the added off in this respect problem of losing trained better paying jobs. workers to "he Project Paper provides part time technical for the recruitment supervisory malaria of full time and who would be expected program staff to provide training from Java and Bali unskilled prsonnel to local Timor para-medical recruited for the and counterpart personel project. However., to work with the without local etc. there can temporary workers from be no transfer of technical Java, Bali no prospect for and management development of a self-sustaining knowledge and malaria coutrol for Timor. program Furthermore, to two the BAPPENAS dcision weeks for those experienced to restrict per diem personnel Java/Bali technical payments coming to Timor on short and supervisory term training or supervisory -2­ assignments has seriously such handicapped the project's personnel. The time ability to recruit from required for most short-term a minimum of 30 days assignemts up to 3 or more months* varies days Anything less than would not be cost effective. 30 Although this constraint particularly serious affects all of Timor, problem in East Timor* is is a largely In West Timor the problem , one of refresher training. is 6.3. Lack of Entomological Information Continued success of any control of malaria residual house spray is dependent on the program for the information including availability of entomological incrimination data on species of Anopheline of the principle vectors present, data vectors in different on each vector for each areas, susceptibility biting potential insecticide, habits of each vector breeding, resting mosquito in relation and people and bio-assay to the habits of the tests of sprayed surfaces. At the present time there being carried is virtually no out in East Timor and entomological activity surveys in West only limited species Timor. There is as and density assigned to yet no M.Sc. Medical either province (one Entomologiest stay). Although was assigned to Kupang, 3 assistant entomologists but did not Timor, both positions have been trained are again vacant. for East in West Timor need The two assistant entomology additional training entomologists program required in order to carry to provide technical out the guidance to the project. The lack status of information on of individual seasonal mosquito densities- resting species,.susceptibility vector and biting habits status of each species, of each vector species and to the future constitutes a constraint success of the program. 6.4. The Lack of Transport Transport DDT is needed in all phases and spraymen with their of the program: ourveys, to update spray equipment, to to deliver geographical reconnaissance, conduct malariometric and to provide superviion. Because of the shortages malaria vehicles of vehicles, or in are being used for some cases because becomes necessary other purposes than to use commercial transport. malaria it rented or borrowed In most cases to deliver DDT, but trucks are the spraymen must walk their own equipment. and carry With the project 4/5 completed of $ 140,000.00 in terms of time budgeted for transport only $ 72,679.00 has been spent. An insufficient number prevents the timely of vehicles and/or program conduct of the field misuse of vehicles and thus constitutes operations in the malaria a constraint to the success of the program. -3­ 7. DISCUSS ON AND KEY RECOMMENDATIONS 7.1. Funding The Team feels funds that delays in the in support of the project timely supply of adequate serious in both East and West problem which if continued Timor is a very made in could reverse the excellent reducing malaria so far. progress able to The Team does not feel pinpoint all of the causes that it has bten utilization of delays in the release of funding and therefore and recommends that: A joint GOI/AID committee of specialists in requested financial matters be to investigate all ramifications involved ii funding of of the delays the Timor Malaria Project recommendations to provide and develbp for a timely flow and the funds utilization of in support of the project. 7.2. Personnel 7.2.1. East Timor In view of turnover of the numerous vacant positions, staff, the difficulty of the high and the difficulty recruiting qualified local of obtaining short term personnel personnel from Java/Bali technical and supervisory for appropriate periods that personnel problems of time, the team constitute Lue greatest feels achievement of the objectives single obstacle to of the project aud therefore that: recommends a. A special effort should be made to recruit, train retain local personnel and at all levels of the program. b. Assistance should be sought from health educators better understand the problem to of recruiting, training and retaining local personnel. c. A request should be made assignment to Bappenas for approval of technical and of supervisory personnel from Java/Bali on per diem to of time Timor for the actual period their services are required up to 3 months and not less than 1 month.
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