ITN Campaign Efficiency Project

Accurate ITN quantification for campaign and continuous distribution channels is critical for achieving and sustaining universal coverage objectives. Quantification challenges include poor quality or outdated census data and significant differences between official populations and microplanning or registered populations during ITN campaigns. In the face of limited resources and a need for sustained ITN access, AMP is investigating existing practices and will recommend quantification approaches that will allow for improved coverage and better targeting of resources across distribution channels for sustained ITN access.

Household registration has been demonstrated to be the most important part of an ITN campaign for ensuring targeted households receive ITNs. Data show that the most common reasons for not receiving ITNs during a mass campaign are that the household was not registered and/or that the household did not receive a voucher to exchange for ITNs at distribution points. AMP will review the costs and methodologies of different approaches to monitoring quality of HHR and will develop operational guidance for planning and implementation of household registration, as well as cost-effective and efficient methods for verifying coverage, quality and outcomes of the household registration itself.

Many national malaria programmes have expressed the need for data post-ITN mass campaign(s), but funding is limited for post-distribution surveys as contributions are focused on larger, population-based surveys such as Malaria Indicator Surveys. AMP will identify cost-effective and robust approaches to assessing campaign outcomes in terms of ITN access and use to ensure data are available for decision-making, more accurate targeting of post-distribution activities and improvements to future mass ITN campaigns.

National malaria programmes are increasingly using digital platforms for collection of data during mass ITN distribution campaigns. The advantages of this electronic information include real-time access, minimized human error (e.g. for calculation of ITNs per household) and improved ability to use data collected for decision making and programmatic improvements. AMP has undertaken a retrospective review on the use of digital tools through key informant interviews with selected national malaria programmes and partners to understand the process, successes, challenges and recommendations related to the transition to digital data collection for their ITN campaign. AMP has also tracked national malaria programmes that have planned to transition from paper-based to digital data collection in their 2022—2023 campaigns. A decision-making matrix has been being designed to help national malaria programmes and their implementing partners analyse their operational needs and context, and determine whether to digitalize their ITN mass campaign, and if so, to what extent. Additionally, AMP is examining facilitators and barriers for transitioning from cash to electronic payment systems.

Mosquito resistance to pyrethroid insecticides is increasing in malaria-endemic countries, threatening the gains that have been made over the last decade through scaled-up vector control. To address the insecticide resistance challenge, new ITN types (PBO, dual active ingredient) have been introduced and are being evaluated. AMP will continue to update multi-product ITN global reference documents based on experiences and best practices in campaigns using a combination of net types. Additionally, AMP is also tracking planned ITN campaigns to provide an overview of campaigns and their status. The ITN campaign tracker is a “living document”, regularly updated, and has been populated with data from either the RBM gap analysis or from information provided by national malaria programmes.

Studies have shown even if mass campaigns can be perfected to reach all households with the right number of nets, ITN access will only reach target levels immediately after the campaign, after which ownership begins to decline quite rapidly. AMP will conduct an analysis of ITN inputs to countries via non-campaign channels to assess the current situation for sustaining ITN access to reach the WHO targets, as well as to identify the gaps that need to be filled. AMP will work to identify systems to ensure continuous, cost-effective access to ITNs through different channels, look across health programmes for effective urban approaches and review social and behaviour change (SBC) funding available for ITN campaigns over the past two campaign cycles. The extent to which net care messages have been included in SBC messages over the past one to two years will be assessed to provide recommendations for the future.

To avoid reversing the gains achieved in malaria control at the start of the COVID-19 pandemic, WHO declared that countries should continue to prioritize ITN distribution through planned campaigns and other channels. AMP rapidly developed a set of recommendations and associated documents such as case studies on modified strategies and innovative efforts to ensure planned ITN distributions continued during the pandemic. AMP has focused on assessing the effectiveness of its technical support provided by distance and identifying key considerations for future support to countries. AMP is also working on evaluating the costs of COVID-19 adaptations for ITN mass campaigns planned and implemented during the first year of the pandemic in several countries to identify the key cost drivers shared by campaigns in the region and provide national malaria programmes with data on the components driving costing changes for application in future campaigns as needed (for COVID-19 or other disease outbreaks).