Cost of Quality Assurance of Malaria Microscopy: The Philippines and Thailand

บทคัดย่อ

For a disease like Malaria which affects people with low socio economic status, quality service promotes equity in health (Wirth et al, 2006). Prompt treatment, one of the four pillars of Roll Back Malaria (RBM), relies heavily on the accurate and timely diagnosis of malaria. This is increasingly apparent as the WHO moves to promote the global use of costly malaria treatments and especially artemisinin-based combination therapy (ACTS). While rapid diagnostic tools (RDT) are in the process of being finessed, malaria microscopy seems to hold its place in malaria diagnosis.

Microscopy has been practised as the predominant malaria diagnostic system in Thailand for several decades, since the inception of the program (Malaria Division, 1980). However, the continued viability of microscopy is threatened by the large scale exit of trained microscopists due to retirement. This problem is exasperated by the historical 'batch' training of microscopists and their subsequent homogenous age. Conversely, the Philippines has only recently invested in microscopy (AusAID-DOH- RBM/WHO, 2004) and while retirement is not currently a constraint, high attrition rates prompted by low salaries, few career opportunities and migration towards overseas work, has increased microscopy costs.

In recognition of these factors, it is imperative that reliable quality assurance (QA) of mircoscopy is maintained, whereby QA refers to the quality monitoring of slide examination to ensure the correct diagnosis of malarial parasitic infection in blood cells and the types of malaria parasites present.

The costs of maintaining a QA scheme must be explicitly recognised and budgeted for not only in Thailand and the Philippines, but also in other regional countries which are contemplating different malaria diagnostic approaches such as Laos and Cambodia.

While it is widely accepted that malaria microscopy is still the mainstay of a malaria control program, the highly technical and resource burden nature of the intervention must be appreciated. The training of microscopists to ensure that they maintain skills and keep good equipment are two issues that make malaria microscopy costly. An assessment of costs, and potential cost savings. involved in maintaining a QA programme for malaria microscopy is instrumental in providing guidance to an improved QA system for malaria microscopy.