Optimizing ITN Access in Africa (OPITACA)

Vector control is at a pivotal moment: malaria budgets have not increased, and funding is insufficient to ensure sustained access to effective tools at the necessary scale. While new ITN products are becoming available that have a demonstrated effect on addressing insecticide resistance and reducing malaria, limited resources will prevent their deployment at scale in many countries. National malaria programmes are forced to fit interventions into existing budget envelopes, potentially leading to procurement of less effective products, as well as adoption of operational strategies that compromise quality and reach of distribution. National malaria programmes must “do more with less”, given insufficient donor and national funding to fully implement their national strategic plans, and must prioritize interventions, seek implementation efficiencies wherever possible, and, in many cases, make difficult trade-offs. AMP will support the operationalization of ITN distribution strategies tailored for specific geographic areas within a country, update planning, budgeting and operational guidance for continuous ITN distribution, evaluate mass campaign strategies, and identify and document effective methods for reaching at-risk populations with limited access to services

The transition from paper-based to digital tools for ITN distribution offers opportunities for optimizing planning and implementation of activities. However, there are concerns from NMPs regarding digitalization including sustainability, data access, local capacity development, costs, device management and reuse, and platform capabilities. Data from digitalized ITN distribution campaigns do not have a clear path to integration into national systems. Reuse of data post-campaign has been limited, driven by questions of data validity and availability. Digitalization solves many problems, but human factors remain, impeding the availability of high quality data for current and future health campaigns. To tackle these issues, AMP will develop and share easy-to-follow operational guidance on ITN campaign digitalization, hold an annual meeting with partners to share challenges and best practices, train AMP technical assistance (TA) providers and staff from NMPs on digitalization, provide technical support to health ministries and NMPs based on requests, and organize experiential learning visits as applicable.

Digital technology will improve timeliness and accuracy of data collected during campaigns, although many of the operational issues, such as misunderstood household definitions, inflation of household size, or splitting of households, will remain difficult to detect in the digital data and will require a different type of quality control to be put in place. While national malaria programmes often implement some type of quality control during household registration and assessment of post distribution outcomes, methods and analysis in many cases remain weak and interpretation of the data is affected by sampling, analysis errors and technical capacity of programme staff. In most cases, the monitoring data and the data in the database are not linked for comparative purposes. AMP will expand the toolkit for clustered lot quality assurance sampling(cLQAS), build the capacity of programmes and partners for planning and implementation, and support national programmes in using the collected data to inform social and behaviour change (SBC) planning for both ITN campaigns and continuous distribution.

Since 2004, over three billion ITNs have been shipped to malaria endemic countries and most countries in Africa have had three cycles of universal coverage mass ITN campaigns over the past decade alone. However, concerns have emerged about their environmental impact and variable durability. Key issues involve the need for sustainable waste management for both nets and their packaging, gaps in policies around net care and repair, repurposing and “end-of-life” nets, and a lack of sufficient data to evaluate national ITN retention and quality, as well as SBC interventions aimed at improving net behaviour. This leads to uncertainty about which nets are most effective. AMP will develop, disseminate, and ensure the uptake of guidance and tools for assessing waste management options. Additionally, AMP will support post-market monitoring of ITNs and facilitate the engagement of NMPs in global-level discussions on ITN quality.

Based on requests, AMP has been providing TA focused on scaling up and sustaining access to ITNs, primarily through mass campaign delivery, to national malaria programmes and their implementing partners for over 15 years. The current TA funding and operating models lack flexibility for short-term needs, highlighting the importance of adopting sustainable, tailored capacity-building and on-the-job learning for NMP staff. AMP will facilitate regular skill-building, mentoring and experience-sharing sessions for TA providers, staff from national malaria programmes and support country exchanges to strengthen technical capacity through in-country peer-to-peer interactions.