Cost and performance of malaria surveillance in Thailand.

Some results are presented from a study to determine the costs and performance of the antiparasite elements of the malaria disease control programme in Thailand. Issues examined in the paper are the concept of cost-effectiveness and its relevance in evaluating health care processes, procedures for measuring the performance of malaria surveillance and monitoring processes and procedures for measuring costs. Some data on the costs and the performance of operational services and control activities in two malaria zones are presented and the paper closes by considering how health economics research can be stimulated and supported in developing countries. It is argued that the cost-effectiveness of malaria surveillance and monitoring processes (and probably many other health care processes) can not be measured retrospectively. In the case of malaria control the effectiveness of each operational services can not be compared because services provided are interactive and complementary rather than alternatives. In addition the targets set and levels of effectiveness achieved may not be the same for these complementary processes. Procedures developed for measuring the performance and costs of malaria operational services and activities are described. Five types of measurement are used to evaluate the performance of the operational services and activities; effectiveness (%); time (days); performance (%); and efficiency (cost/unit). Actual expenditure on malaria operational services and activities is not known since all expenditure of government departments in Thailand is recorded under nine budget headings. Budget expenditure at division, region and zone levels must therefore be apportioned to assess the costs of operational services and activities. Since a variety of criteria may legitimately be used to apportion costs at each level, a network technique was developed which allows examination of the effect of all possible combinations of criteria. By this means the maximum, minimum and most appropriate costs are determined. Examples of the costs and performance of surveillance operational services and activities in two zones are presented. Data illustrates the outcomes from the procedures developed and indicates how malaria disease control managers might interpret and use the information obtained. The paper closes with some observations on how health economics research in developing countries could be better stimulated and supported through staff development programmes and through supervised 'on the job' training.