Net Distribution Roundup: What have we learned?

On October 3, 2018, more than 100 participants joined a webinar hosted by VectorWorks and the U.S. President’s Malaria Initiative (PMI) to discuss the lessons learned from the five-year global insecticide-treated net (ITN) distribution project. The webinar included the latest insights from evaluations and costing studies of routine, school-based, and community-based ITN distributions across sub-Saharan Africa.

The webinar began with a presentation by Dr. Albert Kilian, Technical Director of Tropical Health. Dr. Kilian gave an overview of the effectiveness of continuous distribution in maintaining population access after mass campaign ITN distribution. The evidence shows that antenatal care (ANC) and Expanded Programme on Immunization (EPI) distribution are complementary channels that cannot achieve high population coverage. Adding school and community distribution channels can sustain high levels of ITN access in the long term if the programs are well implemented and conditions are right. Finally, maintaining high levels of ITN access through continuous distribution seems to reduce malaria incidence when compared to areas without continuous distribution. Although there may be concerns about population sub-groups that are missed with continuous strategies – particularly school distribution – Dr. Kilian, during the Q&A, further clarified that in the case of Tanzania, about 15% of households gave nets to friends or family. This, in addition to private sector purchases of nets, led to overall high rates of coverage in the population.

Next, Dr. Joshua Yukich, Assistant Professor at Tulane University School of Public Health, presented cost-effectiveness data on long-lasting insecticide net (LLIN) distribution strategies in sub-Saharan Africa. The current evidence indicates that continuous distribution strategies can be effective at delivering nets and sustaining coverage in-between mass campaigns. Mass campaigns and continuous distribution have similar costs per net delivered; however, continuous distribution involves more in-kind contributions from countries. Because the costs are not significantly different, countries can choose channels based on their operational feasibility, whether it means mass campaigns only, continuous distribution, or a combination. Combining mass campaigns with intermittent school or community distribution is cost-effective only at high historical transmission levels.

The final presentation by Dr. Richmond Ato Selby, Field Operations Director, PMI VectorWorks, focused on tools for planning continuous ITN distribution. The presentation focused on tools to guide countries through various decisions for ITN distribution. The ITN Distribution Strategy Decision Flowchart guides users through a series of considerations that leads them to different ITN channel combinations, based on operational feasibility of various channels. The presentation offered a few tools to assist with planning, including the Continuous Distribution Toolkit and NetCALC, which is being revised to a NetCALC Lite version with a simpler and more user-friendly interface.

Effective malaria prevention now requires a more specific approach, with action informed by locally relevant evidence and operational context to increase efficiency and minimize waste. This webinar aimed to offer information on the various options for ITN distribution and how partners can identify the best combinations for their countries.

For more details, watch the full webinar.

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Jenna Fritz is a current student at Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Carey Business School working on her dual degree, MPH/MBA.

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