Continuous Distribution Toolkit

As malaria cases are increasing amidst global funding uncertainty, ITNs should be optimally deployed to reach all people in need. Strengthening ITN distribution, including continuous distribution, provides important options to consider for improving and sustaining ITN access.

Programme experience has demonstrated that increasing and sustaining ITN access will decrease malaria incidence. According to the 2024 WHO World Malaria Report, in 2023, 73 per cent of households in sub-Saharan Africa had access to at least one ITN, an increase from five per cent in 2000 and 68 per cent in 2015. Malaria funding has not increased in the face of population growth, while ITN commodity costs have increased to address pyrethroid resistance, and variable ITN durability affects ITN retention.

To achieve maximum impact in vector control and reduce malaria transmission, WHO’s Guiding principles for prioritizing malaria interventions in resource-constrained country contexts advise that vector control strategies include the most effective interventions at an optimal scale and frequency.

National malaria programmes are thus encouraged to align with WHO Guidelines for malaria as well as malaria donor recommendations, review operational and financial data, and consider the best mix of distribution channels to maintain ITN access in their settings, noting that appropriate distribution channels will likely include sub-national tailoring.

The AMP ITN Continuous Distribution Toolkit provides operational guidance focused on key activities, resources, country examples and tools to design, plan, budget and implement ITN continuous distribution (CD) programmes.

Recent modelling to compare mass campaigns to large-scale ITN CD approaches and to combinations of campaigns and CD approaches resulted in recommended approaches and population access estimates for 40 countries and concluded that, where ITN retention times are at least 2.5 years, ITN CD strategies “are likely to offer more efficient ways to maintain ITN coverage”.

Therefore, where ITN retention times are below the three years currently common between mass distribution campaigns, it will be important to conduct a more in-depth review of ITN quantification and coverage to more precisely identify the number of ITNs needed to achieve and sustain access. The next step is to review the optimal mix of channels that will most effectively and efficiently deliver those ITNs.

School- and community-based distribution of ITNs require planning and dedicated resources for their operational success. Different approaches to ITN distribution through schools and community channels have been implemented for nearly fifteen years, with both successful results and operational challenges as described in this ITN CD toolkit.

ITN continuous distribution includes distribution of ITNs via:

• Routine health services such as antenatal care (ANC) and Expanded Programme on Immunization (EPI)
• School-based channels (SBD)
• Community-based channels (CBD)

This toolkit is designed for national malaria programmes (NMPs), their technical assistance partners and stakeholders supporting ITN distribution. The toolkit takes a step-by-step approach through decision-making, coordination and implementation of ITN distribution via continuous channels.

This toolkit currently offers ITN school-based distribution channel-specific operational guidance, including:

• Quantification and distribution planning
• Logistics
• Personnel and training
• Social and behaviour change (SBC)
• ITN issuing and supervision
• Data collection and management
• Monitoring, evaluating and reporting

Operational guidance for community-based channels and strengthening delivery through routine health services will be added in due course.

The toolkit guidance comprises six downstream steps (operational planning steps that support planning and implementation of ITN distribution though a selected channel), to be followed once a decision has been made to include SBD in a country’s ITN distribution channel mix. Guidance on decision-making for quantification needs is available here and further upstream steps (strategic planning that informs a country’s ITN channel mix and waste management policy) will be available shortly in AMP Resources. In addition to operational guidance, the CD toolkit contains adaptable tools and country resources that can be downloaded and adapted according to specific contexts.