Planning for distribution

Operational guidance on the planning phases of school-based ITN distribution, including coordination structure, plan of action, timeline and budget, micro-quantification, and assessing and mitigating risks.

Key SBD Considerations

For ITN SBD, the Ministry of Education (MoE), Ministry of Health (MoH), regional and local administrative departments and authorities will be key stakeholders, and it is therefore important to share ITN distribution planning information with their leadership and include representatives of each institution in planning early and often. Terms of Reference (TOR) are an essential tool for describing and clarifying roles and responsibilities for stakeholders and personnel involved in SBD. Use of TORs can support robust operations coordination between partners, beginning with developing the SBD plan of action.

Download: Adaptable ITN SBD terms of reference (TOR) [Word] EN | FR | PT

To begin planning for ITN SBD, it is important to develop a plan of action (PoA). The ITN SBD PoA should align with the National Malaria Strategic Plan and ITN distribution guidelines already in place. As ITN SBD is typically conducted annually, establishing sustainable systems is essential for long-term effectiveness. ITN SBD requires sufficient time and human resources for planning and implementation. It is therefore important to support early planning and coordination led by the NMP and avoid overlap with implementation of other significant malaria or health campaigns (e.g. immunization, seasonal malaria chemoprevention).

Adaptable ITN SBD plan of action (PoA) [Word] EN | FR | PT

As a result of the coordination between the Moh (NMP) and the MoE, the ITN SBD plan should be developed. The table below shows how key activity sections of the PoA map to the upstream and downstream steps in the ITN toolkit.

POA Activity Toolkit step
Setting the ITN distribution goal and objectives Step One
Quantifying ITNs needed and selecting school classes to receive ITNs to achieve ITN access targets Step Two
Managing ITN and ITN packaging waste Step Three
Planning: the detail of how the ITN SBD will be managed Step Four
Logistics for ITN SBD, including planning for local procurement, storage, transport, tracking and accountability Step Five
Identifying and training ITN SBD leaders, trainers and teachers/health educators Step Six
Planning and implementing ITN social and behaviour change Step Seven
Issuing ITNs in alignment with the SBD plan and supervising distribution Step Eight
Collecting and managing data, monitoring and evaluating SBD activities and outcomes, reporting on ITN distribution Step Nine

The following should be considered when developing the PoA:

  • It is critical to include MoE and MoH stakeholders in planning ITN SBD at all levels. Local health and education authorities are often involved as well.
  • Experience has shown that class enrolment numbers may fluctuate/increase during the first semester of the school year. To avoid ITN shortages, NMPs may opt to use second semester data for final micro-quantification and to distribute ITNs during the second semester of the school year. ITN distribution should ideally avoid exam periods and school vacations.
  • Procurement delays are a common concern, and careful planning is needed to ensure ITN availability in time for the scheduled day(s) of distribution within the school calendar.
  • Based on the results of a supply chain risk assessment (Step Five), it is important to develop an accountability plan, which includes strategies and activities for preventing, identifying and mitigating the impact of fraud, theft or diversion of ITNs.
  • Linking activities to other significant school health activities can improve reach and effectiveness and may reduce costs through mutual reinforcement of key malaria prevention and ITN use messages during joint activities.
  • It is recommended to involve all types of schools in the distribution (i.e. public, private, boarding, religious/Koranic) to improve the reach of ITN SBD and ITN access. This will require additional coordination with non-public schools and partners to obtain enrolment data, plan ITN storage and issuing, and collect distribution data and reports. Note for boarding schools, the objective will be to specifically cover individual students while they are at school rather than for students to take their ITN home for use in the household.

Example of an ITN SBD Planning Cycle.

Source: PMI VectorWorks, School-based distribution of LLINs

A key element of the ITN SBD plan of action is a timeline identifying tasks, realistic time-bound targets, key milestones and the focal point(s) responsible for achieving each task. The timeline format can follow a Gantt-style chart with columns for (1) Key activity categories and detailed activities, (2) Deadlines for achievement of key milestones, and (3) Time required for implementing key activities to achieve those milestones.

Download: Adaptable ITN SBD timeline [Excel] EN | FR | PT.

  • In advance of micro-quantification, macro-quantification of ITN needs is an upstream activity that must consider the macro-level needs for all channels in a country’s channel mix. Guidance on macro-quantification is provided in Step Two.
  • As part of Step Four, Planning for school-based distribution, a micro-quantification plan to determine the number of ITNs required for each participating sub-national level (e.g. by region, by district, by school) should be developed.
  • Micro-quantification should use enrolment data from individual schools for the current school year, focusing on the targeted classes. Data should include the number of students enrolled in the current year together with any anticipated drop-outs and planned new arrivals if known.
  • Schools that may have been omitted or new schools that have opened since the macro-quantification data were collected should be accounted for. Adjusting ITN quantities based on changes in enrolment, such as mid-year admissions, may be necessary.
  • In the SBD timeline, data collection for micro-quantification should be planned at the start of a school term in which the distribution will occur. This will help minimize the effect of changes in enrolment on quantification and planning.
  • Depending on country context and level of coordination, workshops with education and health officials at sub-national levels should be considered to discuss and finalize micro-quantification plans. Logistical challenges, such as transport to remote schools, storage of ITNs at school facilities and implementation in complex operating environments (COE) could usefully be addressed at these workshops. The micro-quantification details and any identified challenges will inform the SBD transport plan (Step Five).
  • Relevant lessons from previous distributions should be incorporated when finalizing the micro-quantification plan.

Country example: Macro-quantification and micro-quantification for SBD in Zambia

In Zambia, one ITN is provided to each student in selected classes (termed “grades” in Zambia). ITNs for SBD are procured annually, with macro-quantification based on the number of children in participating districts enrolled in the selected grades the previous year.

Note that in this example, no contingency stock is included in macro-quantification.

The process for micro-quantification is as follows:

  • Copies of class registers for selected grades are submitted by primary school head teachers to their zonal heads.
  • Zonal heads tally the number of schoolchildren in their zone and submit to the district School Health and Nutrition (SHN) focal person.
  • District SHN focal persons validate the tallies and follow-up with all schools with a variance greater than three per cent between the Education Management Information System (EMIS) and class register data.
  • Provincial SHN focal persons validate all data and submit to the national SHN coordinator and National Malaria Elimination Programme (NMEP).
  • The NMEP then facilitates the transport of ITNs to schools based on validated data. Schools without validated data do not receive ITNs.

Source: Zambia SBD Process Presentation SNP Implementation Guide

Country example: Macro-quantification and micro-quantification for SBD in Tanzania

In Tanzania, a one-off quantification workshop using NetCALC (an ITN quantification tool now replaced by the ITN Quantification Site), determined that population x 17 per cent is the appropriate national population quantifier for all CD channels, required to achieve and maintain an ITN access target of 80 per cent. Different regions in Tanzania have different ITN distribution strategies. In each region, the quantifier is adjusted to the ITN strategy to estimate a percentage quantifier relevant for the SBD channel. For example, if ANC and EPI need is estimated at eight per cent of the population in a region, then SBD need would be nine per cent of the population. This quantifier is converted to the number of ITNs for SBD macro-quantification. This quantification is conducted on an annual basis, one year ahead of when nets are supplied to schools.

Having obtained the ITN quantity, the National Malaria Control Programme uses pupil enrolment data as of 31 March in the current year to adjust the number of ITNs in micro-quantification. Validating enrolment data has posed challenges in the past which has led to oversupply and undersupply of ITNs, or the exclusion of a few schools from the SBD. The President’s Office – Regional and Local Government Authorities (PORALG) and Directorate of Education Administration and the Regional Education Department recommend that school enrolment data are validated to ensure all registered schools in their councils are on the list, and the number of pupils in classes is correct.

Source: Tanzania SNP Implementation Guide and personnel communication

The detailed list of activities identified as part of ITN SBD timeline development should be costed to develop a draft ITN SBD budget. Unit costs can be identified and collected by the NMP and partners from recent budget exercises for other health and malaria activities to inform the costing exercise. Once the draft budget has been developed, it should be reviewed by the manager of the NMP, financial and budget focal points at the NMP and partner organizations within the national malaria coordination structure.

Download: ITN SBD planning and budgeting checklist [Excel] EN | FR | PT

The draft budget should contain as much detail as possible to aid realistic budgeting. A detailed list of items is needed for costing each activity. For example, for:

  • Coordination, review and planning meeting costs, e.g. the number of refreshment breaks and/or lunches offered; stationery; printed items; and travel costs for out-of-town attendees if and where these costs are approved and budgeted.
  • ITN commodity procurement costs, and in-country quality assurance (if planned).
  • Printing and distribution costs for training materials, job aids, SBC materials, logistics tracking documentation, ITN issuing forms, reporting forms.
  • Transport of ITNs through the supply chain or third-party logistics agents to school levels, including vehicle rental and associated costs if not included in vehicle rental, e.g. insurance, fuel, driver rates.
  • Storage costs and related security and insurance as needed, if not covered through MoH, MoE and school-based storage during ITN SBD.
  • Labour costs for loading and unloading of ITNs.
  • Phone credit and other communication costs across ITN SBD teams.
  • Teacher training and briefing costs to cover travel, per diem, meals and refreshment breaks, facilitation fees, as well as materials for participants, trainers and training supervisors.
  • Supervision visit costs, to cover travel and per diem for supervisors.
  • Data entry and analysis costs to support additional workloads during and following ITN SBD activities.

Line items for these activities are included in the budget which can be adapted as required.

Based on the distribution strategy, a Risk assessment and mitigation plan should be developed. This plan should describe the key risks to successful implementation and planned mitigation measures. It is important to clearly identify the risk owner, responsible for mitigating and monitoring each risk. The Risk assessment and mitigation plan should be an Excel file that can be reviewed and updated on a regular basis.

Resources

  • Adaptable ITN SBD terms of reference (TOR) [Word] EN | FR | PT
  • ITN SBD plan of action (PoA) [Word] EN | FR | PT
  • ITN SBD timeline [Excel] EN | FR | PT
  • ITN SBD planning and budgeting checklist [Excel] EN | FR | PT
  • ITN SBD risk assessment and mitigation plan [Excel] EN | FR | PT and guidance [Word] EN | FR | PT

Implementation plans and guidance

  • Ghana NMEP (2020). Implementation Guidelines for Continuous Distribution of ITNs for Malaria Control and Prevention in Ghana (Revised 2020)
  • Ghana NMEP and Ghana Education Service (2023). PMI VectorLink School-based ITN Distribution, Orientation of Key Stakeholders [PowerPoint]
  • Tanzania NMCP (2023). School-based ITN Distribution – Implementation Guidelines
  • Zambia NMEC. Guidelines on the Distribution and Utilization of Long-Lasting Insecticide-Treated Nets for Malaria Prevention (2022—2024)

Sub-national guidance

Other resources