Improving LLIN Distribution Through the Use of Mobile Technology
Ghana’s National Malaria Control Program (NMCP) increased the efficiency of long-lasting insecticidal nets (LLINs) distribution through the development and use of NetApp, a mobile application for Android devices, used for data collection and distribution of LLINs. The application eliminates labor intensive manual registration because it calculates and allocates LLINs to households automatically during registration. Additionally, data is stored centrally and can be retrieved when needed, unlike paper-based data storage and retrieval of information.
Hammond N. Sarkwah, the IT focal person for NMCP and architect behind the app, explained that NetApp is “a highly user-friendly application” for real time monitoring of performance throughout a distribution campaign. Dr. Keziah Malm, Programme Manager of the NMCP and the driving force behind the app, noted that, “my busy schedule makes it impossible for me to be in the field all the time, but with NetApp, I am virtually in the field always no matter where I am.” Users in the field have also praised the app. Roland Glover, the Regional Malaria Focal Person of the Ghana Health Service (GHS) for the Volta Region, explained “[Without] NetApp, I would have been struggling with data compilation and manually analyzing LLINs received and distributed. With the app, I am cool.” Kwame Asante, a Registration Assistant in Koforidua in the Eastern Region, asserted that, “it was a lifetime experience for me to use NetApp to make a difference in my community.”
Moving Beyond Paper-based Data Collection
Since 2010, the NMCP and partners have implemented mass campaigns for the distribution of LLINs, as part of the national strategy to reduce malaria transmission. Mass campaigns have helped to rapidly increase household ownership of LLINs by allocating one LLIN to every two people in all registered households. This led to increased household ownership of LLINs (73% of households own at least one LLIN and 51% of households have one LLINs for two persons in a household, according to the MIS 2016). After two national mass campaigns implemented in Ghana (2010–2012 and 2014–2016), the NMCP and partners sought to harness available technology to enhance efficiencies in household registration and distribution. This led to the introduction of a locally developed mobile application deployed on handheld electronic mobile devices.
NetApp was developed by NMCP/GHS. The vision for a technology-based solution came from Dr. Malm, who is passionate about the use of technology to drive the implementation of malaria interventions in the country. She challenged the staff of the NMCP to come up with a tool to assist with registration and distribution of LLINs. Beginning in August 2017, and over the course of two months, the NMCP worked with a dynamic team of its own developers to create the tool in preparation for the October 2017 pilot exercise held in four districts in the Eastern and Volta regions. The purpose of the pilot exercise was to test the app, to document the practical lessons learned and inform necessary changes prior to scaling up the use of NetApp during the 2018 mass distribution of LLINs, running from October 2017 through the end of 2018. With support from the U.S. President’s Malaria Initiative (PMI), VectorWorks provided discrete technical support to the NMCP/GHS on app testing and refinement during the development phase; VectorWorks also provided technical support and recommendations for improvement through an evaluation process conducted in early 2018.
Findings and Scale up
NetApp is seen as a resounding success and an improvement over paper-based distribution. The pilot exercise uncovered several areas for improvement, such as poor Internet connectivity, making it difficult to upload data; log in challenges due to poor internet network coverage, making it impossible to log into the app in the afternoon; and multiple synchronization, resulting in duplicate data. The developers also realized a need for configuring particular data fields to prevent inputting inaccurate data, such as mistakenly including telephone numbers in the field intended for household size, which led to over-estimation of the number of LLINs needed. These and other issues uncovered in the pilot exercise were addressed by the developers to improve the use of NetApp during subsequent phases of the 2018 mass distribution campaign.
To date, use of NetApp has increased efficiency and accuracy of LLINs registration and distribution. It has greatly increased visibility of data, which has helped in quickly identifying poor performing districts where rapid action was needed. Each community is pre-populated in NetApp for quick registration, and the app automatically allocates LLINs needed per household based on the household size, reducing the time previously required for health workers to manually compute, allocate LLINs and fill out summary sheets. This also reduced the occurrence of human error associated with paper, and mitigated risk of stealing and over/under-quantifying nets. Additionally, NetApp rapidly increased availability of data, resulting in a two-day data validation period, a vast improvement over the two weeks needed to validate data gathered through paper-based household registration. This allows for real-time decision-making when an unexpected event occurs, such as an over or under supply of LLINs to a site. NetApp makes it possible to track each Registration Assistant and Distribution Point Assistant via its GPS location function when they are working online and helps respond quickly as issues arise.
The pilot exercise achieved distribution of 202,725 LLINs to 116,013 households; 92.2% of the estimated population was registered, while 80.4% of the allocated LLINs were distributed. This was an improvement over previous paper-based mass distributions. By mid-September 2018, 9,325,143 LLINs had been distributed across 6 regions using NetApp, and PMI VectorWorks staff applauded the use of NetApp for LLINs distribution. Senior Technical Advisor Prince Owusu noted that paper-based registration was quite challenging; data compilation errors such as mistakes in calculation of nets created quantification challenges, and over or under supply of LLINs, as well as shortages and audit queries. “The benefit of NetApp is that it is efficient; it gets the process done in the shortest possible time. After registration is done, we have real-time data, it is all done by the press of a button.” PMI VectorWorks’ Chief of Party Sylvester Segbaya noted that NetApp “significantly improved the quality of data for LLIN distribution. The program [has] real time ability for tracking the entire process.”
At the end of the 2018 mass distribution campaign, the NMCP and partners will reassess challenges and lessons learned to inform the future use of NetApp. The intention is for the app to be used more widely on other health areas as determined by GHS. Additionally, a presentation at the 2018 Vector Control Working Group Meeting (VCWG) in Geneva inspired the interest of other countries in adapting NetApp for their own use in mass campaigns.