Assessing options for an innovative malaria control program on the basis of experience with the new Colombian Health Social Security System

objectives: designing and proposing alternative models for municipal and departmental malaria control programmes based on evidence obtained concerning the process of malaria on the colombian pacific coast and regarding key problems in the malaria control programme before and following health system reform in 1993. methods: an evaluative study was carried out, comparing the situation before and following the 1993 reform; model design was also compared. control programme is understood as being the institution, the human group and administration in charge of control activities. the study was carried out in 2002 and 2003, in the departments along the colombian pacific coast; the four departmental capitals, 28 malarial and 5 control municipalities were included primary and secondary information was obtained by means of surveys and semi-structured interviews, community meetings and reviewing documentation in the secretariats of health, the vector-borne disease control programme-vbdc, the expanded immunisation programme-eip, health promoting entities-hpe, subsidised regime administrators-sra and service-providing entities-spe. results: the following results were obtained: 1. illustrating and analysing malarial tendencies in the country and on the pacific coast, and the corresponding institutional transformations in the programme; 2. characterising the control programme which existed before 1993; 3. characterising departmental modes of decentralising the programme; 4. identifying the effects of reforming the system and characterising control programme problems; 5. comparing the programme with the expanded immunisation programme (eip); 6. comparative analysis of the programme and identifying current gaps in management capability; 7. actors' perceptions regarding the control programme; 8. values and challenges for an innovative control programme; and 9. designing a model for up-dating/adapting the control programme. discussion: malaria control programmes' problems and weaknes