Results from the NATNETS Programme National Malaria Control Programme Tanzania Presentation for RBM...

NATNETS Programme Tanzania

Results from the Results from the NATNETS Programme NATNETS Programme

National Malaria Control National Malaria Control Programme TanzaniaProgramme Tanzania

Presentation for RBM / WINPresentation for RBM / WINMarch 1-3 2006March 1-3 2006

Nick Brown, ITN Cell Team Leader, NMCPNick Brown, ITN Cell Team Leader, NMCP


NATNETSNATNETS

ITN Cell in the National Malaria Control ITN Cell in the National Malaria Control Programme (funded by Swiss Agency for Programme (funded by Swiss Agency for Development & Cooperation)Development & Cooperation)

Tanzania National Voucher SchemeTanzania National Voucher Scheme (funded by (funded by GFATM Round 1)GFATM Round 1)

SMARTNET Social Marketing Programme SMARTNET Social Marketing Programme (funded by DFID/RNE)(funded by DFID/RNE)

A long-term multi-donor, multi-partner initiative to A long-term multi-donor, multi-partner initiative to promote the national use of ITNs made up of promote the national use of ITNs made up of three complementary interventions:three complementary interventions:


ApproachApproach

Establishing and promoting the ITN Establishing and promoting the ITN

Public Private Partnership to ensure:Public Private Partnership to ensure:

AffordabilityAffordability

AccessibilityAccessibility

AcceptabilityAcceptability


Tanzanian National Voucher SchemeTanzanian National Voucher SchemeThe Four Contracting PartnersThe Four Contracting Partners

LogisticsLogistics: Voucher printing, distribution, : Voucher printing, distribution, administration and redemption: MEDAadministration and redemption: MEDA

Training & PromotionTraining & Promotion: World Vision Tanzania / : World Vision Tanzania / CARECARE

Monitoring & EvaluationMonitoring & Evaluation: LSHTM / Ifakara HRDC: LSHTM / Ifakara HRDC

AuditAudit: KPMG: KPMG


MEDA /

Namitech

Wholesalers

Manufacturers

District Medical Officers

& RCH Clinics

Pregnant

WomenRetailers

Voucher Books

Individual VouchersRedeemed

Vouchers

Redeemed Vouchers

The TNVS Voucher Flow

Individual Vouchers

Redeemed vouchers


TNVS Voucher Value & Prices of NetsTNVS Voucher Value & Prices of Nets

Tzs 2,750 ($2.50 approx)Tzs 2,750 ($2.50 approx)

Retail Net prices vary from Tzs. 3,500 - 4,450 depending Retail Net prices vary from Tzs. 3,500 - 4,450 depending on size of net and remotenesson size of net and remoteness

All nets manufactured in Tanzania are bundled with an All nets manufactured in Tanzania are bundled with an Insecticide Treatment KitInsecticide Treatment Kit

Top Up paid by women varies from Tzs 750 – 1700 Top Up paid by women varies from Tzs 750 – 1700 (average = 1,019)(average = 1,019)

Top Up price represents retailer’s marginTop Up price represents retailer’s margin

Retailer can only exchange vouchers for more netsRetailer can only exchange vouchers for more nets


Achievements of TNVS Achievements of TNVS

>1.27 million vouchers distributed to DMOs and >1.27 million vouchers distributed to DMOs and clinics by the end of 2005clinics by the end of 2005

Hati PunguzoHati Punguzo is now operational in all 21 Regions is now operational in all 21 Regions

National Coverage (last remaining districts) will be National Coverage (last remaining districts) will be achieved by early April 2006achieved by early April 2006


Hati Punguzo Hati Punguzo vouchers issued to vouchers issued to DMOs and clinics by 2005 year endDMOs and clinics by 2005 year end

Vouchers Issued

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Q2 Q3 Q4 Q5 Q6

Actual

Target


Hati Punguzo Voucher Hati Punguzo Voucher Redemption RatesRedemption Rates

414,878 vouchers 414,878 vouchers redeemed by the redeemed by the year endyear end

Currently >545,000 Currently >545,000 vouchers redeemedvouchers redeemed

Voucher redemption Voucher redemption rates exceeded the rates exceeded the monthly target for the monthly target for the first time in first time in December 2005December 2005

Vouchers Redeemed

0

10000

20000

30000

40000

50000

60000

70000

80000

Oct-05 Nov-05 Dec-05

Target

Actual

Cumulative Total Number of Vouchers Redeemed

0

100,000

200,000

300,000

400,000

500,000

Q2 Q3 Q4 Q5 Q6


Growth of the Commercial Sector Growth of the Commercial Sector stimulated by TNVSstimulated by TNVS

Four Tanzanian Net ManufacturersFour Tanzanian Net Manufacturers A-ZA-Z SunflagSunflag TMTLTMTL MotexMotex

WholesalersWholesalers

RetailersRetailers


Growth of the Commercial Sector Growth of the Commercial Sector stimulated by TNVSstimulated by TNVS

Number of Retailers and Wholesalers

0

500

1000

1500

2000

2500

3000

Q2 Q3 Q4 Q5 Q6

Wholesalers

Retailers

ITNs are now widely ITNs are now widely available in remote rural available in remote rural areas due to growth of areas due to growth of the retail sectorthe retail sector

2,618 retailers involved 2,618 retailers involved by end Decemberby end December

80% of these retailers are 80% of these retailers are new to the ITN businessnew to the ITN business


Growth of Commercial ITN Sales and Growth of Commercial ITN Sales and Re-Treatment KitsRe-Treatment Kits

Sales of ITNS in 2005 Sales of ITNS in 2005 reached 2.4 million, reached 2.4 million, 34% higher than 200434% higher than 2004

Sales of insecticide Sales of insecticide re-treatment kits re-treatment kits (IRKs) > 3.175 million, (IRKs) > 3.175 million, 44% higher than 200444% higher than 2004

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

2001 2002 2003 2004 2005

Sales of Bednets in Tanzania 2001-2005

Unsubsidised Nets LLINs TNVS Voucher Sales Free Nets

0

1,000,000

2,000,000

3,000,000

4,000,000

2001 2002 2003 2004 2005

Growth of Insecticide Re-Treatment Kits 2001-2005

Commercial Sales of Ngao Retreatment Kits IRKs Distributed under TNVS


Other Achievements of TNVSOther Achievements of TNVS

As a result of TNVS, As a result of TNVS, clinics are reporting clinics are reporting increased attendance and increased attendance and are seeing women earlier are seeing women earlier in their pregnancyin their pregnancy

In launched districts In launched districts awareness of awareness of Hati Hati Punguzo Punguzo ranges from ranges from 52% (household heads) 52% (household heads) to 71% (pregnant women to 71% (pregnant women leaving clinics)leaving clinics)

01020304050607080

HouseholdHeads (HS)

PregnantWomen (HS)

RCH Users (ES)

Awareness of Hati Punguzo in Household (HS) and Exit (ES) Surveys (June-Aug 2005)

Not Launched TNVS Launched


Bednet Coverage EstimatesBednet Coverage EstimatesPregnant Women (HH Surveys)Pregnant Women (HH Surveys)

These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS

Early launched districts were closer to Dar es Salaam and probably had higher Early launched districts were closer to Dar es Salaam and probably had higher coverage to start withcoverage to start with

Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched

Show Desktop.scf

0.0%

10.0%

20.0%

30.0%

40.0%

Late Middle Early

Coverage Estimates by TNVS Launch Status from LSHTM/IHRDC Household Survey

(June-Aug 2005)

Coverage (ITN)

Coverage (untreated net)


Bednet Coverage EstimatesBednet Coverage EstimatesChildren <5 (HH Surveys)Children <5 (HH Surveys)

0.0%

10.0%

20.0%

30.0%

40.0%

Late Middle Early

Coverage Estimates (<5s) by TNVS Launch Status from LSHTM / IHRDC Household Survey (June-Aug

2005)

Coverage (ITN)

Coverage (Untreated)

These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS Early launched districts were closer to Dar es Salaam and may have had higher coverage to start Early launched districts were closer to Dar es Salaam and may have had higher coverage to start

withwith Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched


Bednet Coverage EstimatesBednet Coverage EstimatesPregnant Women (Exit Surveys)Pregnant Women (Exit Surveys)

These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS

Early launched districts were closer to Dar es Salaam and may have had higher Early launched districts were closer to Dar es Salaam and may have had higher coverage to start withcoverage to start with

Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched

0%

20%

40%

60%

80%

Late Middle Early

Coverage Estimates by TNVS Launch Status from LSHTM / IHRDC Exit Survey

(June-Aug 2005)

Coverage (ITN)

Coverage (untreated net)


Bednet Coverage by Socio–Economic Status Currently Bednet Coverage by Socio–Economic Status Currently Pregnant Women (from LSHTM/IHRDC HH Survey Pregnant Women (from LSHTM/IHRDC HH Survey

June-Aug 2005)June-Aug 2005)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Q5 (leastpoor)

Q3 Q1(poorest)

Any Net

Ever Treated

Recently Treated


Current & Future Bednet Current & Future Bednet Coverage EstimatesCoverage Estimates

Since the household and exit surveys were Since the household and exit surveys were conducted, a further 375,000 vouchers have conducted, a further 375,000 vouchers have been redeemed by pregnant women, been redeemed by pregnant women, representing 27% of the estimated PW representing 27% of the estimated PW populationpopulation

A further 375,000 vouchers are expected to be A further 375,000 vouchers are expected to be redeemed within the next four months, prior to redeemed within the next four months, prior to the next round of M&E surveysthe next round of M&E surveys


IssuesIssues

Widespread shortages of ANC Widespread shortages of ANC cards in many (40) districts cards in many (40) districts means many women are being means many women are being denied a voucherdenied a voucher

GFATM Phase 2 Agreement GFATM Phase 2 Agreement Letter still unsigned, four Letter still unsigned, four months after commencement months after commencement of Phase 2.of Phase 2.

Women in poorest socio-Women in poorest socio-economic group (Q1) are economic group (Q1) are >50% less likely to be given a >50% less likely to be given a voucher as the least poor voucher as the least poor group (Q5)group (Q5)

0%10%

20%

30%

40%

50%

60%

Q5 (leastpoor)

Q4 Q3 Q2 Q1(poorest)

Probability of Pregnant Women Being Given an HP Voucher according to Socio-Economic Status

(Source: RCH Exit Surveys June-Aug 2005)


TNVS Programme CostsTNVS Programme Costs

Once nationwide coverage is achieved, 1.1-1.2 million nets will Once nationwide coverage is achieved, 1.1-1.2 million nets will purchased with vouchers per yearpurchased with vouchers per year

Annual cost of Phase 2: $5.5 millionAnnual cost of Phase 2: $5.5 million

Price per net delivered incl. subsidy, 2 re-treatment kits, logistics, Price per net delivered incl. subsidy, 2 re-treatment kits, logistics, training, promotion, audit and administrationtraining, promotion, audit and administration

= $4.55 - $4.96 = $4.55 - $4.96 eacheach

Delivery cost (logistics, training, promotion, audit & admin): Delivery cost (logistics, training, promotion, audit & admin):

=$1.79 - $1.97 per =$1.79 - $1.97 per netnet


Next StepsNext Steps

Advocacy and Retraining Programme to address the Advocacy and Retraining Programme to address the right of right of allall pregnant women to receive vouchers pregnant women to receive vouchers (March/April)(March/April)

Introduction of KO Tab 123 (April onwards)Introduction of KO Tab 123 (April onwards)

Feasibility study for transfer of factory pre-treatment Feasibility study for transfer of factory pre-treatment technology to Tanzanian manufacturers (current)technology to Tanzanian manufacturers (current)

Additional subsidy for 200,000 OlysetAdditional subsidy for 200,000 Olyset™ nets™ nets

USAID/PMI ProgrammeUSAID/PMI Programme


Expanding the TNVSExpanding the TNVSUSAID/PMI Programme 2006USAID/PMI Programme 2006

Infant Voucher in 15 RegionsInfant Voucher in 15 Regions

Equity (“Safety Net”) Voucher in 12 Equity (“Safety Net”) Voucher in 12 DistrictsDistricts

Long Lasting Insecticide Treated Net Long Lasting Insecticide Treated Net (LLIN) Technology Transfer(LLIN) Technology Transfer


TNVSTNVS Infant VoucherInfant Voucher

Delivered at 9 months with measles Delivered at 9 months with measles vaccinationvaccination

Value = Tzs 2750 (same as PW voucher)Value = Tzs 2750 (same as PW voucher) Funding in Year 1 to reach 15 RegionsFunding in Year 1 to reach 15 Regions Selection CriteriaSelection Criteria

Infant MortalityInfant Mortality Excluding regions and districts that have Excluding regions and districts that have

recently received free netsrecently received free nets


TNVS Equity VoucherTNVS Equity Voucher

Targeted at the most needyTargeted at the most needy

Selection and Delivery Mechanism to be determinedSelection and Delivery Mechanism to be determined

Probably a top-up voucher over and above the PW & Probably a top-up voucher over and above the PW & Infant VoucherInfant Voucher

Value to be determined (range Tsh 750 -1500) if a top upValue to be determined (range Tsh 750 -1500) if a top up

Funding in Year 1 to reach 12 districtsFunding in Year 1 to reach 12 districts

District Selection by Poverty Indicator & Infant MortalityDistrict Selection by Poverty Indicator & Infant Mortality


Next Steps - Medium TermNext Steps - Medium Term((Subject to full approval of PMI programme)Subject to full approval of PMI programme)

Expansion of Infant Voucher from 15 to all Expansion of Infant Voucher from 15 to all 21 regions (from 2007)21 regions (from 2007)

Introduction of <5 voucher (from 2007)Introduction of <5 voucher (from 2007)

Expansion of Equity Voucher (2007-2010)Expansion of Equity Voucher (2007-2010)


AcknowledgementsAcknowledgements Our donorsOur donors

GFATMGFATM SDCSDC DCIDCI DFID/RNEDFID/RNE

Swiss Tropical InstituteSwiss Tropical Institute

Our Contracting PartnersOur Contracting Partners MEDAMEDA World Vision / CAREWorld Vision / CARE LSHTM / IHRDCLSHTM / IHRDC PSIPSI KPMGKPMG

The Tanzanian Net ManufacturersThe Tanzanian Net Manufacturers

Karen KramerKaren Kramer

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