Many countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context. The Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings. The theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level dose–response analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument. This framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate- or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels.

中文翻译：

---

在中等和低传播环境中评估疟疾规划：产生可靠证据的实用方法。

许多国家在扩大规模和维持疟疾干预覆盖率方面取得了实质性进展，从而导致在许多情况下更加集中和多样化的传播。评价为计划提供了宝贵的信息，以了解干预措施是否按计划和质量实施，是否对疟疾负担产生了预期影响，并指导计划决策。由于动态和有针对性的干预策略，低速，中速和异构传输设置提出了独特的评估挑战。本文提供了这些传输设置的评估方法和方法的说明，并提出了如何回答特定于本地环境的评估问题的建议。遏制疟疾监测和评估参考小组于2017年10月成立了一个工作组来领导该框架的开发。该工作队包括来自国家疟疾规划，资助机构以及疟疾研究和实施伙伴的代表。该框架以流程和结果评估以及影响评估的现有指南为基础，特别是在高传播环境中。变革理论描述了国家疟疾计划在不同情况下提出的评估问题如何影响评估设计。传输设置，现有分层以及数据质量和可用性也是关键考虑因素。该框架旨在使各国适应当地情况，并用于国家以下各级的评估。建议将确诊的疟疾发病率作为主要的影响指标，因为它对检测低传播环境变化的敏感性很高。预计过程评估将为计划的监测和改进提供足够的证据，而在采取新的干预措施，操作策略，工具或政策的新组合之后，尤其是在疟疾流行病学不断变化的情况下，需要进行影响评估。在低度，中度或非均质传播环境中的影响评估可能会使用合理性设计，框架强调的方法包括中断的时间序列，区级剂量反应分析和构建的控制方法。对多个数据源和分析进行三角剖分对于加强合理性论证很重要。该框架提供了一个结构，可协助国家疟疾规划和合作伙伴设计低，中或异种传播环境下的评估。该框架强调将过程评估与影响评估，然后进行方案决策联系起来的因果路径的连续循环，该框架为评估设计，分析和解释提供了实践指导，以确保评估符合国家疟疾规划的优先问题并指导决策。在国家和国家以下各级。