DESIGN, MONITORING AND IMPLEMENTATION OF THE …...prevalence (˜g. 1). Target class for SNP4 was...
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In SNP4, the previous Southern regions were maintained and 4 new Lake Zone regions of Geita, Mara, Mwanza and Kagera were added making the total number of LLINs distributed 1,132,043. This would maintain more than 80% coverage in the target regions that also have high malaria prevalence (fig. 1). Target class for SNP4 was 1-5 and 7 in Ruvuma and Mtwara while in Lindi, class 1-4 and 7 were selected based on the estimated LLIN coverage levels. In the new Lake Zone regions, LLINs were distributed only to class 1 students due to both high coverage levels from the recent mass campaign and high student enrolment due to the new free education policy instituted by the government of Tanzania in 2016. Table 1: LLINs distributed through SNP 3 and SNP 4 Figure 1: LLINs distributed through SNP 3 and SNP 4 2. IMPROVED EFFICIENCY IN SNP4 DESIGN & IMPLEMENTATION A. Centralized quantification of students’ data In the past rounds of SNP, ward education officers were trained to collect pupils’ data. In SNP4, VectorWorks used centralized data collected by the government. Upon receiving these data, CCP worked with government to validate the data, which was proved to be 95% accurate. B: LLINs re-bundling on the go to avoid storage cost and time During SNP 3, LLINs were delivered to districts based on quantification data. LLINs were stored at the district warehouse for 7-10 days to allow re-bundling of LLINs in stacks equivalent to quantified school needs. In SNP 4, LLINs were delivered to districts by 40' trucks, which were offloaded to smaller trucks (verified by district officials), ready for delivery to schools. Rebundling (breaking of bales) happened only during offloading of LLINs for a particular school. This helped to save time and substantially reduced distribution costs. C. Automated pre and post delivery notifications The notifications were sent to ward education coordinators, who supervise two to six schools in each ward. This information included when LLINs would arrive, how many LLINs each school would receive, and a reminder that a representative should be available to receive the LLINs at the specified time of delivery. BACKGROUND In 2011, the Ministry of Health and the National Malaria Control Program of Tanzania developed a Keep Up Strategy with the goal of maintaining the population’s access to a long-lasting insecticidal net (LLIN) at or above 80%, by using school-based distribution as an innovative distribution channel. This strategy was piloted in Tanzania’s Southern Zone beginning in 2013, when the NMCP distributed 421,285 LLINs in three regions. By August 2016 Tanzania has implemented four annual rounds of school-based distribution in three southern regions. SNP2 was implemented in 2014 by Research Triangle Institute, delivering 489,099 ITNs. In the third round in 2015, Johns Hopkins Center for Communication Programs' (CCP) VectorWorks project with partner PSI delivered 494,407 LLINs. VectorWorks also implemented the 4th round in August 2016, delivering 1,132,043 to 5,054 schools in the Southern Zone and in the northern Lake Zone area. METHODS Working with a multi-sectoral task force including Ministry of Health, Ministry of Education, and local government, enrollment data was gathered from the government’s centralized data collection system and later verified through a series of validation checks, and used to quantify deliveries for each school. After training and delivery of LLINs to schools, teachers distributed LLINs to the eligible students in the targeted classes, and provided behavior change messages on net use, care, and malaria prevention. Upon delivery of LLINs to schools, a delivery officer entered the quantity delivered as well as the name and contact information of the receiving personnel into an app. The app automatically captured GPS location and updated the status of delivery and automatically these sent to a central, cloud-based database, which VectorWorks staff and staff from private distributor Simba Logistics could access remotely to monitor deliveries in real time to ensure deliveries were being made to the right locations in the right quantities. SNP IMPLEMENTATION PROCESS RESULTS 1. INCREASED LLIN ACCESS During SNP3, 494,407 LLINs were delivered in three regions of Lindi, Mtwara and Ruvuma to students in classes 1-3, 5, & 7 in Ruvuma and Mtwara and 1-5 & 7 in Lindi to achieve LLIN coverage levels above 80%. Using data currently available, NetCALC modelling indicates that the best estimate for population access to an LLIN within the household following SNP3 is approximately 74% in Mtwara and Ruvuma, and 89% in Lindi. Waziri Nyoni 1 , David Dadi 1 , Noela Kisoka 1 , Peace Nyankojo 5 , Dismas Mwalimu 2 , Renata Mandike 2 , Ally Mohamed 2 , George Greer 3 , Naomi Kaspar 3 , Karen Kramer 2, 4 , Gabrielle Hunter 1 , Hannah Koenker 1 , Matt Lynch 1 1 VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, United States, 2 Tanzania National Malaria Control Program, Dar es Salaam, Tanzania, 3 PMI Tanzania, Dar es Salaam, Tanzania, 4 Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania, 5 PSI Tanzania, Dar es Salaam, Tanzania Presentation number 2673 Geita SNP3 LLINs distributed SNP4 LLINs distrubuted 0 145131 0 129542 0 160851 0 120669 188738 213813 169849 242034 135820 120003 494,407 1,132,043 Kagera Mwanza Mara Mtwara Ruvuma Lindi TOTAL DESIGN, MONITORING AND IMPLEMENTATION OF THE THIRD AND FOURTH ROUNDS OF SCHOOL NET DISTRIBUTION TO MAINTAIN UNIVERSAL ACCESS TO LONG-LASTING INSECTICIDAL NETS IN SOUTHERN TANZANIA Step 1: National Level macro planning Step 2: Regional & Districts advocacy Step 3: Cascade training/orientation Step 4: Quantification of pupils Step 5: Validation of quantified data Step 6: Micro plans Step 7: LLIN re-bundling & transportation Step 8: LLIN issuing Lindi Mtwara Ruvuma Kagera 1.125 0.9 0.675 0.45 0.225 0 SNP3 SNP4 Mwanza Geita Mara Dominic Nyamboga from Simba Logistics checks the number of LLINs delivered using an app on his phone in Mara Region, Tanzania. © 2016 Riccardo Gangale/VectorWorks, Courtesy of Photoshare In the previous rounds of SNP, reporting on LLINs distributed was done through the implementing project. In SNP4 reporting is being done by and through the government’s integrated open data dashboard, which is publicly available through the government website, strengthening Tanzanian ownership of the distribution. 3. TRANSPARENCY IN ACCOUNTING FOR LLINS Using technology to improve accountability Previous rounds of SNP used paper invoices to account for LLINs. It took about 7 days for all paperwork to travel to the central office before reconciliation happened. In SNP4, VectorWorks used a mobile phone and web-based system to ensure that deliveries were made to the correct locations in the correct quantities. This made the entire process faster and increased accountability as any discrepancies could immediately be traced to exactly where they occurred in the supply chain. 4. REINFORCED MALARIA PREVENTION BEHAVIOR THROUGH SCHOOL CHILDREN ITN issuing alongside social and behavior change communication (SBCC) messaging encouraged children to be advocates for net use in their community. As one of the most at-risk groups for malaria, young children were taught the importance of sleeping under LLINs every night to protect themselves and their families. 5. BOLSTERING SCHOOL ATTENDANCE In communities across Tanzania, malaria exacts a significant toll, particularly among young children. It is one of the primary reasons for school absenteeism, often leading to failure and dropout. The children recognized the danger of malaria in their communities, but for many of their families the cost of an LLIN is simply too high. Providing an LLIN to sleep under protects children from contracting malaria, leaving them healthy enough to attend school. 6. INTEGRATED REPORTING THROUGH GOVERNMENT OPEN DATA WEBSITE CONCLUSION LLIN distribution through schools in Tanzania is a viable channel to sustain coverage levels by maintaining access rates at or above 80%. VectorWorks has greatly improved efficiency in delivering LLINs through a transparent accountability system and integrating the design and implementation of the program into existing Government of Tanzania systems which has led to reduced costs. The next rounds of SNP will see even more improvement in both the design and implementation of the school net program. This poster is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) under the terms of USAID/JHU Cooperative Agreement No AID-OAA-A-14-00057. The contents do not necessarily reflect the views of PMI or the United States Government. Contact: Waziri Nyoni, [email protected]
Transcript of DESIGN, MONITORING AND IMPLEMENTATION OF THE …...prevalence (˜g. 1). Target class for SNP4 was...
In SNP4, the previous Southern regions were maintained and 4 new Lake Zone regions of Geita, Mara, Mwanza and Kagera were added making the total number of LLINs distributed 1,132,043. This would maintain more than 80% coverage in the target regions that also have high malaria prevalence (�g. 1). Target class for SNP4 was 1-5 and 7 in Ruvuma and Mtwara while in Lindi, class 1-4 and 7 were selected based on the estimated LLIN coverage levels. In the new Lake Zone regions, LLINs were distributed only to class 1 students due to both high coverage levels from the recent mass campaign and high student enrolment due to the new free education policy instituted by the government of Tanzania in 2016.
Table 1: LLINs distributed through SNP 3 and SNP 4
Figure 1: LLINs distributed through SNP 3 and SNP 4
2. IMPROVED EFFICIENCY IN SNP4 DESIGN & IMPLEMENTATIONA. Centralized quanti�cation of students’ dataIn the past rounds of SNP, ward education o�cers were trained to collect pupils’ data. In SNP4, VectorWorks used centralized data collected by the government. Upon receiving these data, CCP worked with government to validate the data, which was proved to be 95% accurate.
B: LLINs re-bundling on the go to avoid storage cost and timeDuring SNP 3, LLINs were delivered to districts based on quanti�cation data. LLINs were stored at the district warehouse for 7-10 days to allow re-bundling of LLINs in stacks equivalent to quanti�ed school needs. In SNP 4, LLINs were delivered to districts by 40' trucks, which were o�oaded to smaller trucks (veri�ed by district o�cials), ready for delivery to schools. Rebundling (breaking of bales) happened only during o�oading of LLINs for a particular school. This helped to save time and substantially reduced distribution costs.
C. Automated pre and post delivery noti�cations The noti�cations were sent to ward education coordinators, who supervise two to six schools in each ward. This information included when LLINs would arrive, how many LLINs each school would receive, and a reminder that a representative should be available to receive the LLINs at the speci�ed time of delivery.
BACKGROUNDIn 2011, the Ministry of Health and the National Malaria Control Program of Tanzania developed a Keep Up Strategy with the goal of maintaining the population’s access to a long-lasting insecticidal net (LLIN) at or above 80%, by using school-based distribution as an innovative distribution channel. This strategy was piloted in Tanzania’s Southern Zone beginning in 2013, when the NMCP distributed 421,285 LLINs in three regions. By August 2016 Tanzania has implemented four annual rounds of school-based distribution in three southern regions. SNP2 was implemented in 2014 by Research Triangle Institute, delivering 489,099 ITNs. In the third round in 2015, Johns Hopkins Center for Communication Programs' (CCP) VectorWorks project with partner PSI delivered 494,407 LLINs. VectorWorks also implemented the 4th round in August 2016, delivering 1,132,043 to 5,054 schools in the Southern Zone and in the northern Lake Zone area.
METHODSWorking with a multi-sectoral task force including Ministry of Health, Ministry of Education, and local government, enrollment data was gathered from the government’s centralized data collection system and later veri�ed through a series of validation checks, and used to quantify deliveries for each school. After training and delivery of LLINs to schools, teachers distributed LLINs to the eligible students in the targeted classes, and provided behavior change messages on net use, care, and malaria prevention.
Upon delivery of LLINs to schools, a delivery o�cer entered the quantity delivered as well as the name and contact information of the receiving personnel into an app. The app automatically captured GPS location and updated the status of delivery and automatically these sent to a central, cloud-based database, which VectorWorks sta� and sta� from private distributor Simba Logistics could access remotely to monitor deliveries in real time to ensure deliveries were being made to the right locations in the right quantities.
SNP IMPLEMENTATION PROCESS
RESULTS1. INCREASED LLIN ACCESSDuring SNP3, 494,407 LLINs were delivered in three regions of Lindi, Mtwara and Ruvuma to students in classes 1-3, 5, & 7 in Ruvuma and Mtwara and 1-5 & 7 in Lindi to achieve LLIN coverage levels above 80%. Using data currently available, NetCALC modelling indicates that the best estimate for population access to an LLIN within the household following SNP3 is approximately 74% in Mtwara and Ruvuma, and 89% in Lindi.
Waziri Nyoni1, David Dadi1, Noela Kisoka1, Peace Nyankojo5, Dismas Mwalimu2, Renata Mandike2, Ally Mohamed2, George Greer3, Naomi Kaspar3, Karen Kramer2, 4, Gabrielle Hunter1, Hannah Koenker1, Matt Lynch1
1VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, United States, 2Tanzania National Malaria Control Program, Dar es Salaam, Tanzania, 3PMI Tanzania, Dar es Salaam, Tanzania, 4Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania, 5PSI Tanzania, Dar es Salaam, Tanzania
Presentation number 2673
Geita
SNP3 LLINs distributed SNP4 LLINs distrubuted
0 145131
0 1295420 160851
0 120669
188738 213813169849 242034
135820 120003
494,407 1,132,043
Kagera
Mwanza
MaraMtwara
RuvumaLindi
TOTAL
DESIGN, MONITORING AND IMPLEMENTATION OF THE THIRD AND FOURTH ROUNDS OF SCHOOL NET DISTRIBUTION TO MAINTAIN UNIVERSAL ACCESS
TO LONG-LASTING INSECTICIDAL NETS IN SOUTHERN TANZANIA
Step 1: National Level macro planning
Step 2: Regional & Districts advocacy
Step 3: Cascade training/orientation
Step 4: Quanti�cation of pupils
Step 5: Validation of quanti�ed data
Step 6: Micro plans
Step 7: LLIN re-bundling & transportation
Step 8: LLIN issuing
Lindi Mtwara Ruvuma Kagera
1.125
0.9
0.675
0.45
0.225
0
SNP3SNP4
Mwanza Geita Mara
Dominic Nyamboga from Simba Logistics checks the number of LLINs delivered using an app on his phone in Mara Region, Tanzania. © 2016 Riccardo
Gangale/VectorWorks, Courtesy of Photoshare
In the previous rounds of SNP, reporting on LLINs distributed was done through the implementing project. In SNP4 reporting is being done by and through the government’s integrated open data dashboard, which is publicly available through the government website, strengthening Tanzanian ownership of the distribution.
3. TRANSPARENCY IN ACCOUNTING FOR LLINSUsing technology to improve accountabilityPrevious rounds of SNP used paper invoices to account for LLINs. It took about 7 days for all paperwork to travel to the central o�ce before reconciliation happened. In SNP4, VectorWorks used a mobile phone and web-based system to ensure that deliveries were made to the correct locations in the correct quantities. This made the entire process faster and increased accountability as any discrepancies could immediately be traced to exactly where they occurred in the supply chain.
4. REINFORCED MALARIA PREVENTION BEHAVIOR THROUGH SCHOOL CHILDRENITN issuing alongside social and behavior change communication (SBCC) messaging encouraged children to be advocates for net use in their community. As one of the most at-risk groups for malaria, young children were taught the importance of sleeping under LLINs every night to protect themselves and their families.
5. BOLSTERING SCHOOL ATTENDANCEIn communities across Tanzania, malaria exacts a signi�cant toll, particularly among young children. It is one of the primary reasons for school absenteeism, often leading to failure and dropout. The children recognized the danger of malaria in their communities, but for many of their families the cost of an LLIN is simply too high. Providing an LLIN to sleep under protects children from contracting malaria, leaving them healthy enough to attend school.
6. INTEGRATED REPORTING THROUGH GOVERNMENT OPEN DATA WEBSITE
CONCLUSIONLLIN distribution through schools in Tanzania is a viable channel to sustain coverage levels by maintaining access rates at or above 80%. VectorWorks has greatly improved e�ciency in delivering LLINs through a transparent accountability system and integrating the design and implementation of the program into existing Government of Tanzania systems which has led to reduced costs. The next rounds of SNP will see even more improvement in both the design and implementation of the school net program.
This poster is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) under the terms of USAID/JHU Cooperative Agreement No AID-OAA-A-14-00057. The contents do not necessarily re�ect the views of PMI or the United States Government.
Contact: Waziri Nyoni, [email protected]
