A systems thinking framework for assessing and addressing malaria locally: An alternative to the globalization of anti-malaria policies.
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文摘
This dissertation analyzes a decision system that was used in the early 1900s in the Federated Malay States FMS) by Malcolm Watson in order to make anti-malaria program recommendations to decision makers in a wide range of ecological settings. Watsons recommendations to decision makers throughout the FMS led to a dramatic suppression of malaria morbidity and mortality in numerous communities in different ecological settings. In addition, Watson learned over time how to achieve the same suppression of malaria through the implementation of interventions that required fewer resources. A key factor in the ability of Watsons decision system to facilitate learning was the systematic integration of malaria system information relationship between malaria indicators and malaria risk factors) and implementation information relationship between the resources allocated to implement interventions and the change in their coverage indicators) from numerous communities. The dynamic nature of Watsons decision system enabled him to modify his recommendations as new information became available. The decision system Watson used to facilitate evidence-based learning shares many characteristics with systems thinking. I formalize how Watsons decision system can be applied today through my presentation of the Evolutionary Learning through the Integrated Networking of Knowledge ELINK) decision system. This decision system contains three components: Impact-Implementation Assessment decision framework, Malaria System Assessment methodology and the Retrospective Implementation Assessment methodology. I contrast these double-loop methodologies with the current methodology that is most commonly used to evaluate anti-malaria interventions -- cost-effectiveness analysis CEA). I illustrate the single-loop characteristics of CEA and why it should not be used to evaluate environmental management interventions, the interventions that were primarily implemented in the FMS from 1902 through 1920. The potential for the results of CEA studies of anti-malaria interventions to generate faulty learning is also illustrated. Finally, I estimate the impact of the anti-malaria programs implemented in the FMS on economic growth and development. I discuss why current attempts to develop models to prospectively estimate the impact of suppressing malaria through anti-malaria programs on GDP and GDP per capita will be extremely challenging. In any case, estimates provided by these models will have minimal relevance for policy makers.