Implement distribution

• Single-day in-class distributions have been successful in multiple countries.
• Experience shows that most eligible students are present on the day of the ITN distribution. For example, data from Tanzania have shown that 94 per cent of eligible students were present. However, for students absent on the day of the ITN distribution, only 84 per cent receive an ITN post-distribution. Therefore, post-distribution activities should be carefully reviewed and planned.
• It is important to inform parents and caregivers of the ITN SBD several days in advance. In some countries and contexts, responsible adults or older siblings accompany younger students home on distribution day to reinforce security.
• SBC should accompany ITN distribution in line with the ITN SBD SBC plan (see Step Seven).
• In general, monetary incentives beyond training per diems are not recommended for ITN SBD. ITNs could be provided to teachers and school staff involved in the ITN SBD activities, but the cost of this must be considered as well as how to avoid supplying the same teacher with an ITN every year.
• In the case that the number of eligible students present on ITN distribution day exceeds the number of available ITNs, planners may consider organizing small ITN buffer stocks to be available at schools or at district medical stores. However, experience of use of off-site buffer stocks has been low, in part because of the high accuracy of SBD planning as well as the logistical challenges of accessing off-site stocks.

• ITN issuing guidance should be developed for eligible classes, shared with all involved in ITN distribution day, and included as a key component of ITN SBD training and tools.
• Issuing guidance should cover detailed steps for ITN distribution to eligible students, recording of ITNs distributed, aggregating and reporting issuing data.
• The head teacher and/or classroom teacher/health educator are often responsible for ITN issuing.
• To ensure accountability, identifying more than one teacher and/or school administrator to be involved in issuing, recording, aggregating, validating and reporting data could be considered.
• ITNs should be issued to students on the designated distribution day, accompanied by communication as per the SBC plan.
• ITNs remaining after ITN distribution day, and after providing ITNs to any pupils absent on distribution day, should be recorded as surplus ITNs and returned to the designated location. The agreed action should be described in the logistics section of the PoA (Step Five).

Alongside accountability planning (Step Four), ITN SBD supervision provides immediate feedback to ITN SBD personnel for performance improvement of their skills and practice; reviewing the data reported; verifying physical stocks of ITN and other supplies; checking the availability of tools and documents for ITN stock management, distribution and issuing; identifying and addressing challenges; and providing on-site technical support. Wherever feasible, incorporate MoH personnel in supervision – both for extra support during supervision as well as to leverage their malaria expertise and ITN distribution experience.

The SBD PoA should describe a plan for SBD supervision to reinforce ITN SBD accessibility and quality objectives. It should guide the recruitment and deployment of supervisors to review adherence to procedures, and the quality of ITN SBD. The plan should include an approach to sampling and selecting sub-national areas, schools, communities and/or health facilities to visit; clear roles and responsibilities for each supervisor cadre; supervision checklists to collect information and insights on ITN SBD quality and effectiveness; a timeline; as well as approaches for communicating and addressing challenges as they arise.

If supervisors will receive a per diem or will be otherwise compensated for their work, details of the payment plan and details guiding the payments should be included in the PoA.

Successful implementation of ITN SBD requires supervision at many levels. At least once during ITN SBD, focal points and/or coordination teams at national and sub-national levels should conduct supervisory visits. For example:

• National health and education levels should conduct supervision visits to a selection of sub-national areas and/or school levels.
• Sub-national, (e.g. province, region) health and education levels should conduct supervision visits to a selection of sub-national areas and schools implementing ITN SBD.
• Sub-national division health and education levels should conduct supervision visits to a selection of sub-national division and schools implementing ITN SBD.

The primary objectives of these supervision visits include observing ITN SBD distribution, logistics and data collection, identifying challenges and supporting sub-national colleagues in troubleshooting and overcoming challenges, as well as promoting ongoing improvement of ITN SBD implementation and results.

Supervision tools should be developed for ITN SBD personnel across levels:

• Supervision checklists developed with and validated by the national malaria programme and the MoE. Checklist forms may include a review of adherence to procedures, SBC, quality of service and ITN provision.
• Supervision reports should be collated and findings used to inform planning for subsequent rounds of ITN SBD.

ITN SBD implementation in Ghana

• ITNs are distributed free of charge in two primary classes in Ghana. In previous years this has been the second and last classes of primary school.
• Distribution is conducted according to class register and enrolment figures.
• Distribution is led by the District Director of Education and District School Health Education Programme (SHEP) Coordinator in conjunction with the head of school and school-based health coordinator and the eligible class teachers.
• Reporting of distribution is completed through one paper-based form at the school level, the school distribution form (Form A) which is completed during the distribution, in alignment with the class register/enrolment.
• The class teacher, head teacher and circuit supervisors sign and validate the data and sign Form A after distribution. The signed form is kept at each school.

Source: Ghana NMEP (2023). School-Based ITN Distribution slide deck for the orientation of key stakeholders, Ghana NMEP (2020). Implementation Guidelines for Continuous Distribution of Insecticide Treated Nets

ITN SBD Implementation in Zambia

• ITNs are distributed to pupils in Classes 1 and 4.
• ITNs received from the district are distributed to children in all schools in eligible classes on a designated distribution day.
• ITNs given to children are documented on the Class LLIN Distribution Form that is provided to schools.
• Children are required to write their own names on the distribution form under the supervision of their class teachers after receiving an ITN.

Source: Zambia NMEC ITN SBD Campaign 2021 Final Report

ITN SBD implementation in Zambia: reporting and managing

Reporting and managing ITNs following ITN SBD activities

• Teachers submit their Class LLIN Distribution Forms to school head teacher and school health and nutrition (SHN) focal person for sign off.
• Schools submit the Class LLIN Distribution Forms and any unused ITNs to the zonal head teacher.
• The zonal head teacher compiles all distribution forms for their zone and submits them to the district SHN coordinator.
• The district SHN coordinator compiles the report on ITNs distributed in schools for their district and submits the report to the Provincial Education and District Health offices.
• The provincial SHN coordinator compiles and shares the provincial report with the national level. The report includes documentation and information on ITNs received and distributed.
• The NMEP ITN focal person reviews the reports and share the results with stakeholders, including the CD Coordination Working Group and ITN TWG.

Source: Zambia NMEC SBD Process Presentation

ITN SBD implementation in Tanzania: information sharing

“Just in Time” ITN transport and ITN issuing

• ITN transporters supply ITNs and ITN issuing forms as per the supply plan including:

Form A – Class level Issuing Form

Form B – School level Issuing Form

• All ITNs and ITN forms are entered into the school ledger book, which is used to issue out ITNs and ITN forms. Class teachers then issue ITNs to pupils in eligible classes, in the classroom (not elsewhere) following the instructions on Form A.
• Pupils’ names should only be recorded on Form A when they receive the ITN, and each pupil should sign or put a thumbprint.
• SBC material is also provided to each pupil, where available.

Source: Tanzania NMCP (2023). School-based ITN Distribution Implementation Guidelines

ITN SBD implementation in Tanzania

• After issuing, the class teacher submits the Class Issuing Form (Form A) and any remaining ITNs to the head teacher, who verifies the data and compiles into the School Issuing Form (Form B).
• The head teacher with academic and health teachers can then redistribute remaining ITNs to pupils in non-eligible classes who are from poor families or, as an incentive, to those not performing well in their studies.
• One copy of Form B is provided to forward to the council level and one copy filed at the school.
• Ward Education Officers (WEO) visit all schools to validate the data.
• Councils transfer validated data to the School Information System (SIS) and prepare and share the SNP Implementation Report with council and regional authorities.
• Regional officials then share the SNP Implementation Report at the national level.
• National meetings to assess regional level are then conducted and SIS information shared with key stakeholders.

Source: Tanzania NMCP (2023). School-based ITN Distribution Implementation Guidelines

• ITN SBD supervision checklist for schools [Word] EN | FR | PT

• Zambia NMEC [PDF] School net distribution in Luapula – Success story