No two contexts are the same when it comes to distributing ITNs in complex operating environments (COE) and humanitarian response settings. Demographic, geographic, and logistic challenges all differ by the scale and type of conflict, but lessons can be learned across countries and interventions that will support improved planning to better provide access to ITNs within displaced populations. AMP and partners are helping to both bridge gaps in knowledge on the most at-risk populations in COE settings and highlight successful adaptations national malaria programmes have made to their ITN campaigns.
Two AMP partners, UN Foundation and UN Development Programme (UNDP), have been working to map areas of displaced populations against malaria incidence data, as well to assess inclusion of displaced populations in Global Fund applications. It is important for national malaria programmes to know where displaced populations are located in order to plan for operational changes when delivering ITNs either through campaign or continuous distribution systems (Figure 1). Equally important is ensuring that internally displaced populations (IDPs) and refugees are represented in Global Fund grants (Figure 2) and Global Fund mechanisms, such as the Country Coordinating Mechanism. The mapping and analysis allow countries better visibility of where displaced populations are within their countries and their malaria risk, and ensure the operational adaptations needed to reach these groups are included within Global Fund funding requests.
As more information becomes available, national malaria programmes and partners will be better able to prepare for ITN distribution to displaced populations, which may include important operational adaptations. AMP has been supporting ITN distribution in COE countries for over 15 years through direct technical assistance and has developed the comprehensive Operational guidance for ITN distribution in complex operating environments (COE). To complement this guidance document and highlight particular adaptations made in different humanitarian settings, AMP and partners have developed a case study series focused on four countries.
- Mozambique: Cyclone Idai: In March 2019, central Mozambique was caught in one of the worst cyclones recorded in the Southern Hemisphere. Cyclone Idai made landfall in the city of Beira, bringing severe rains and floods that swept away homes, personal belongings and, of course, insecticide treated mosquito nets. The initial distribution of mosquito nets focused on the growing population in official and unofficial internally displaced people camps. Additionally, coordination with the cholera vaccine campaign maximized the reach of mosquito nets. This case study highlights how partner coordination and integration with other emergency response activities is critical to maximize all available resources and ensure effective emergency ITN delivery.
- Uganda: Refugee populations: In recent years, Uganda has seen an influx of refugees due to conflicts in neighbouring South Sudan, Burundi and Democratic Republic of the Congo (DRC). One of the main services provided to incoming refugees is malaria prevention through the distribution of ITNs to ensure that both the host communities and the refugees are protected. This case study highlights how a phased approach that promotes health screening and provision of malaria commodities (ITNs) for new refugees before integration into settlements and/or camps can help mitigate malaria transmission from the outset.
- South Sudan: IDP populations during COVID-19: A mass campaign in Northern Bahr el Ghazal State (NBeG) where many IDPs are located was planned for early 2019 but was postponed to early 2020 due to extensive flooding, which left over 245,000 IDPs in affected areas at the end of 2019. Planning was under way when COVID-19 was first reported. This case study highlights lessons learned from the ITN distribution in NBeG that might be applicable to other country programmes planning campaigns in COE that experience unknown or high number of COVID-19 cases.
- Cameroon: Conflict displacement: The North Western Region (NWR) is one of two English-speaking regions of Cameroon, where malaria is one of the leading causes of morbidity and mortality. The malaria situation has been exacerbated by the socio-political context. This case study highlights two strategies that were identified for the ITN distribution in the NWR prior to the onset of the COVID-19 pandemic – fixed post “hit and run” and door-to-door – in line with the security context of the area. The strategy adopted for each health area was chosen during health area advocacy meetings based on pre-defined criteria.
These case studies are just the start of AMP’s efforts to highlight the growing gaps in vector control access and use among displaced populations. Through continued partnership and planning across sectors, national malaria programmes and key actors in emergency response can take specific and targeted actions to simultaneously prevent malaria outbreaks following emergencies and enhance emergency response efforts by leveraging existing systems put in place for malaria control and prevention. However, the response to humanitarian emergencies is beyond the means of the health system or any community to handle alone. Effective multisectoral action and coordination with national malaria programmes and actors in the humanitarian cluster system are critical to both the fight against malaria and rapid and impactful emergency response.