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CLOSE THIS BOOKGuidelines on the Use of Insecticide - Treated Mosquito Nets for the Prevention and Control of Malaria in Africa (WHO - MAL - WHO - AFRO - WHO, 1997, 88 p.)
10. Annexes
VIEW THE DOCUMENTAnnex 1. Events contributing to end use of ITMNs
VIEW THE DOCUMENTAnnex 2. Examples of estimating required number of mosquito nets: (net targeting focused on special risk groups)
VIEW THE DOCUMENTAnnex 3. Examples of estimating required number of mosquito nets: (targeted for an entire population at risk)
VIEW THE DOCUMENTAnnex 4. Information to guide ITMN implementation
VIEW THE DOCUMENTAnnex 5. Potential sources of information for ITMN programmes
VIEW THE DOCUMENTAnnex 6. Roles/responsibilities of potential partners
VIEW THE DOCUMENTAnnex 7. Framework for collaborative/partnership planning
VIEW THE DOCUMENTAnnex 8. Examples of monitoring process targets and monitoring indicators
VIEW THE DOCUMENTAnnex 9. Examples of operational research priorities

Guidelines on the Use of Insecticide - Treated Mosquito Nets for the Prevention and Control of Malaria in Africa (WHO - MAL - WHO - AFRO - WHO, 1997, 88 p.)

10. Annexes

Annex 1. Events contributing to end use of ITMNs

NCMC = National Coordinating Committee for Malaria Control

MC = Malaria Control Programme

n = national level

c = central level

d = district level

p = peripheral level

com = community level


Activities

By whom & (at what level)

How/mechanism

Conditions/Support needs

Political commitment

Establish policy framework

Ministry of health, macro-economic level policy/decision makers (n)

Collaboration/participation of NCMC

Relevant technical and policy implied information

Institutional set up and characteristics

Establish institutional, collaborative framework

Policy, decision makers, health services, NCMC
(n, c, d, p, com)

Macro-level in collaboration with NCMC; clarify roles

Motivated partners, collaborators; clear responsibilities

Incorporate MC/ITMNs in health systems reform structures

Ministry of Health,
NCMC, MC
(n, c)

Macro-level decisions, in consultation with NCMC

Health systems reforms planned/ongoing

Define & delegate responsibilities

NCMC, MC
(n, c, d)

Participatory, decisions led by MC

Clear idea of needs from each actor

Establish framework to motivate workforce

NCMC
(n, c)

Develop formal/informal processes

Managerial commitments

Establish procurement systems

Macro-economic level, NCMC
(n, c)

Interact with import regulatory bodies

Commitment/motivation macro-level decisions

Planning

Establish target priorities

NCMC, MC
(c, d)

Stratification, analysis of information/data

Reliable information & efficient information management system

Prepare plans of action

NCMC, MC programme planners
(c, d)

In consultation with district level, other relevant partners

Clarified objectives, resource status

Make needs assessments

NCMC, MC programme planners
(n, c, d, p, com)

In consultation with district level, other relevant partners; compare with available and needs according to plan, assess targets

Information on available, additional needs

Information, education and communication

Establish/maintain efficient information management system

NCMC, MC
(n, c, d, p)

Plan, exchange/use information, computerization

Trained, motivated personnel; processes for information flow

Convince policy/decision makers, financing bodies (DSAs, and ESAs)

Malaria control programme managers/scientists, NCMC
(c)

Demonstrate/highlight disease problem, potential role of ITMNs and promotional needs

Convincing data, information, and presentation

Create motivated workforce

NCMC, MC, all partners
(c, d, p, com)

Recognize/appreciate contributions Give special remunerations

Processes/mechanisms to recognize exceptional contributions

Mobilize community

All partners
(c, d, p, com)

KAP surveys, IEC, training, skills

Knowledge on communities' needs, attitudes, perceptions, practices, interest, resources

Use insecticide-treated nets properly

Individuals, households, communities
(com)

IEC on potential, & conditions for use

Community awareness, knowledge, interest, access, affordability

Technical information and choices

Assess needs-resources, training and research

NCMC, MC
(n, d, com)

Situation analysis, collaboration

Proper planning, & information

Provide information on insecticides, nets, sources, specifications, costs, safety aspects to the providers & implementers

MC personnel
(c, d, p)

Interaction with WHO, industry, dissemination of information, documentation guidelines, newsletters

Efficient information management systems, regular access to new information

Choose insecticide(s), formulations, dosages

Scientists of NCMC, MC (n, c)

Local experiences Seek guidance Use information system

Access to information knowledge, guidance, insecticide registration, vector susceptibility

Select treatment method: dipping or spraying

District level implementers
(d, p, com)

Estimate number of nets to be treated & decide

Knowledge on local needs and on methods

Select monitoring indicators

Scientists in MC, academic/research institutes

Decisions according to target objectives

Clear objectives, guidance

Establish treatment processes, undertake (re)treatments on schedule

Relevant scientists, field implementers
(d, p, com)

Prepare (re)treatment schedules, mobile systems

Treatment sites, access to insecticides/basic supplies on time, trained/skilled personnel, and delivery services

Training

Provide guidance

Competent technical personnel
(c, d, p)

Use guidelines, training material

Availability of guidelines, training material, knowledge, skills

Train for treatments

Trainers, implementers
(c, d, com)

Select trainers, trainees, implementers and train

Knowledge skills, facilities

Funding

Mobilize funds

a) Central level, NCMC (n, c)

b) Malaria control programme managers & NCMC
(c, d)

a) Convince financing bodies, seek support

b) Needs assessment, convince policy & decision makers, interact with potential donors, & partners

National level commitment to malaria control and financing, donor interests, and commitment, sound plans of action

Procurement, local manufacture

Make timely and effective bulk procurements

NCMC, MC managers, NGOs, donors
(c, d, com)

Coordinate country's needs for a specified period, use of national, regional or sub-regional procurement systems (to be established)

Efficient procurement system(s), import tax/duty exemptions, knowledge on specifications, sources, costs

Purchase/sell at costs, subsidized prices

Net-users, immediate providers
(c, d, com)

Suitable distributory channels, subsidized costs

Cost recovery systems

Information on sources/distribution systems, low costs, affordability, access/availability, storage, distribution channels at all levels

Obtain/procure material, promote local sewing of nets

All promoters, supporters, implementers, NGOs
(c, d, com)

Encourage NGOs community, community-based and cost-recovery systems, private sector; provide information on specifications, facilitate access to sewing machines

Community, private sector, NGO interest Access to netting/material, sewing machines Information on designs, measurements, sizes, mesh, denier, loans to buy, subsidized costs, donations, seed money

Promote/encourage, commercial manufacture of nets in the country

Decision/policy makers, NCMC

Remove/reduce tax, regulatory measures, provide subsidies, loans to business/consumer

Commitments, recognition of the need, guidance, monitoring, supervision

Storage and delivery, marketing

Store nets and material properly

Implementers
(n, c, d, p, c)

Seek storage facilities within & outside health sector

Easily accessible storage near or within target areas

Retail nets, netting/material

Implementers
(n, c, d, p, com)

Identify/access to distributory mechanisms within and outside health including private sector

Infrastructures, distribution processes
Access to transport, other delivery systems

Distribute to stores & user levels/treatment sites

District level management
(c, d)

Seek help of other delivery systems

Access to transport, delivery mechanisms/schedules
Storage sites near/within target areas

Ensure insecticide (re)treatments on schedule

Providers, implementers, individuals, households, communities (d, p, com)

Establish treatment sites, mobile arrangements, seek treatments

Planning, insecticide availability on time, (re)treatment mechanisms, access to (re)treatments sites, skills knowledge, awareness

Financing: subsidies, grants, cost recovery

Sale at cost, or at subsidized prices

Managers of MC, community organizations
(d, p, c)

Cost-recovery systems, through suitable government channels, NGOs, community organizations, private commercial sector/shops

Price control, cost-recovery systems, financial management processes, monitoring and supervision

Provide free (exceptionally)

MC/health services, managers of ITMN programmes
(d, p)

Prioritize targets, prioritize/identify those at highest risk, deserving free

Information on most deserving i.e high risk/cannot afford; resources/funds

Provide seed money, financial, and managerial support to community-based net delivery systems

Planners, managers
(c, d, p)

Cost recovery systems, subsidized supplies, donor inputs

Availability of seed money, donor support

Meet costs of (re)treatments: free, subsidized, or at full cost

Net users, managers, implementers
(c, d, com)

Support from public funds, cost-recovery systems

Financial commitment and management/cost recovery mechanisms, affordability

Monitoring, evaluation, quality control

Ensure adherence to policies, standards

Planners, managers, supervisors of malaria control & ITMN implementers
(n, c, d)

Disseminate relevant information, provide guidance, monitor including procurements, supervise, undertake quality control

Guidelines, information, knowledge, competence and resources/facilities for quality control

Ensure proper mixing, dosage, treatment, drying of treated nets

Managers, implementers (c, d, com)

Training, monitoring, supervision, quality control

Guidelines, knowledge, information, skills

Quality assurance of pyrethroids used

Scientists of control programmes, academic, research institutes
(n, c, d)

Special studies, collaborate with academic, research institutes, networking programme

Access to quality control facilities, external/WHO support

Ensure continued efficacy (including vector amenability) to pyrethroids in use

Make quality assurance of pyrethroids used & treatment efficacy

Undertake resistance monitoring

MC, academic, research institute scientists
(n, c, d)

Vector resistance monitoring, field investigations, Bioassays & chemical analysis on samples of treated nets Collaborate with research/academic institutes

Skills, training, supplies, access to field material

Access to quality control facilities

Special studies, external (WHO) support

Ensure net washing preferences, i.e. to wash before (re)treatments, avoid/minimize after treatments, when washed often to get retreatments

Providers, supporters, implementers of ITMNs (d, p, com)

IEC on requirements, provide treatments opportunities

Communication opportunities, access to treatment facilities, resources for lECs

Ensure proper use of treated-nets

Providers, implementers (d, p, com)

IEC including on conditions for proper use, benefits etc.

Communication opportunities, resources

Monitor operational process, target indicators

MC and ITMN programme managers and implementers
(c, d, p)

Based on sound plan with clear indicators, formats, guidelines, etc.

Monitoring plan, resources, defined indicators and processes

Assess impact on disease

MC and ITMN programme managers and implementers, and researchers
(n, c, d)

Use of surveillance data, sample surveys, specific plans developed

Efficient information management & surveillance systems, good recording, reporting

Operational research

Identify operational research needs

MC and ITMN programme managers and implementers, and researchers
(n, c, d, p, com)

Consultation among MC and ITMN programme managers and implementers and researchers

Knowledge/exposure, field operations, experiences, issues of concern including non-response to intervention

Carry out problem-solving research

MC personnel, research/academic institutes
(n, c, d)

In collaboration with malaria control, field implementers

Resources, skills technical inputs/guidance

Support operational research

Planners, supporters/funding agencies
(n, c)

Provide resources/funds, guidance, technical inputs

Competence, resources, guidance

Guidelines to country-specific needs

Develop country-specific handbook based on AFR guidelines

MC staff in collaboration with other partners
(c, d, p, com)

Adapt accommodated to national/local needs

Exposure to field, real life issues and needs

Annex 2. Examples of estimating required number of mosquito nets: (net targeting focused on special risk groups)

Year

1

2

3

4

5







Total population

12,000,000

12,360,000

12,730,800

13,112,724

13,506,106

Proportion living in stable malaria transmission areas

66.70%

66.70%

66.70%

66.70%

66.70%

Proportion aged 0-4 years

18.40%

18.40%

18.40%

18.40%

18.40%

Proportion aged 15-44 years

41.30%

41.30%

41.30%

41.30%

41.30%

Population living in stable malaria transmission areas

8,004,000

8,244,120

8,491,444

8,746,187

9,008,573

Number of children aged 0-4 years living in stable malaria transmission areas

1,472,736

1,516,918

1,562,426

1,609,298

1,657,577

Number of people aged 15-44 years living in stable malaria transmission areas

3,305,652

3,404,822

3,506,966

3,612,175

3,720,540

Number of females in age group 15-44, assuming a sex ratio of 1:1

1,652,826

1,702,411

1,753,483

1,806,088

1,860,270

Proportion of pregnant women aged 15-44 living in stable malaria transmission areas

25.00%

25.00%

25.00%

25.00%

25.00%

Number of pregnant women in a stable malaria transmission areas (SMTA)

413,207

425,603

438,371

451,522

465,068

Target protection coverage for children 0-4 years

50.00%

50.00%

50.00%

50.00%

50.00%

Number of children 0-4 years covered by the program

736,368

758,459

781,213

804,649

828,789

Number bednets for children age 0-4 years assuming that 2 children sleep under 1 bed net

368,184

379,230

390,606

402,325

414,394

Target protection coverage for pregnant women

50.00%

50.00%

50.00%

50.00%

50.00%

Number of pregnant women under the impregnated bed nets intervention living in SMTA

206,603

212,801

219,185

225,761

232,534

Number of pregnant women provided bet nets in previous years

-

41,321

75,617

104,331

128,617

Number of new bed nets required for pregnant women each year

206,603

171,481

143,569

121,430

103,917

Number of children aged 0-4 provided bed net in the previous year

-

276,138

284,422

292,955

301,743

Number of new bed nets for children aged 0-4 years each year

368,184

103,092

106,184

109,370

112,651

Total number of bednets required for children 0-4 and pregnant women (at 50% coverage)

574,787

274,572

249,753

230,800

216,568

Annex 3. Examples of estimating required number of mosquito nets: (targeted for an entire population at risk)

Year

1

2

3

4

5

Total population

12 000 000

12 360 000

12 730 800

13 112 724

13 506 106

Proportion (%) living in stable transmission areas

66.7

66.7

66.7

66.7

66.7

Proportion (%) living in unstable transmission areas

20.00

20.00

20.00

20.00

20.00

Population living in stable transmission areas

8 004 000

8 244 120

8 491 444

8 746 187

9 008 573

Population living in unstable transmission areas

2 400 000

2 472 000

2 546 160

2 622 545

2 701 221

Total population to be protected

10 404 000

10 716 120

11 037 604

11 368 722

11 709 794

Number of nets required to protect entire population

5 202 000

5 358 060

5 518 802

5 684 361

5 854 897

Number of nets required to protect 50% of population

2 601 000

2 679 030

2 759 401

2 842 180

2 927 448

Annex 4. Information to guide ITMN implementation

A. Types of General Information

1. Country background e.g. major socio-economic, demographic, and climatological.

2. National policy on ITMNs, and existing institutional and collaborative arrangements for malaria control, and (if any) for ITMN activities.

3. Major areas/situations in the country likely to be priorities for ITMN implementation, i.e. areas with high malaria-related mortality and morbidity, and severe malaria, drug resistance problem, and high and seasonal transmission, and with other special risk groups such as mobile populations, refugees moved to highly endemic areas.

4. National structures/authorities responsible for, or could facilitate or influence:

¨ Establishment of policy, institutional and collaborative framework for health services and malaria control;

¨ Exemption of taxation/duty on imported materials;

¨ Creation of opportunities for local production of material including removal/reduction of regulatory measures which may deter local manufacture;

¨ Registration, and decisions on insecticide imports in particular for public health and IIMNs;

¨ Establishment of procurement systems;

¨ Interaction/co-ordination with support agencies (domestic and external) of national malaria control and ITMN programmes;

5. Types of ongoing health sector reform structures/processes which can accommodate ITMN related issues.

6. National Institutes of Public Health, academic and research institutes, and scientists involved in ITMN related work, or with such potential.

7. Existing formal and informal structures within and outside the health services (both public and private), and community-based ones involved in, or have the potential to participate in ITMN services.

8. Types, status, magnitude of ongoing ITMN activities (organised or ad hoc) in the country.

9. Types of experiences (positive & negative), of other community based programmes, on community mobilisation, inter-sectoral activities, in the involvement of volunteers so that they may be used as examples for extrapolation, or may be avoided in ITMN programmes.

B. Types of ITMN target/delivery specific information

1. Transmission intensity and seasonality.

2. Disease status/incidence: Estimates on mortality/morbidity (or parasitological if available) especially in relation to children and pregnant women.

3. Estimated populations

¨ In the general (major) administrative areas within which ITMN activities are envisaged;

¨ In the specified areas where ITMN operationalization is ongoing/planned;

¨ Involved in each type of high/special risk population groups, i.e. children under 5 years;

¨ Pregnant women, displaced persons/refugees;

¨ In different types of high or special risk areas, e.g. with drug resistance problem.

4. Entomological/vector related information: The main vectors and their host feeding preferences, biting locations (inside, outside houses), the periods of maximum feeding, and recent information on vector susceptibility status to insecticides in use and to be used for net-treatment.

5. Nets/material, insecticides, insecticide-(re)treatment:

Nets:

¨ types, material, designs, mesh sizes, etc. of nets which are most suitable and are available or accessible, their sources and costs;

¨ types (material, sizes, shapes) commonly used by target communities.

Sewing nets: suitable measurements, designs.

Insecticides: recommended/suitable, the types, formulations, dosages; sources/costs.

(Re)treatment of nets:

¨ Opportunities/facilities for net-treatment (locations of treatments, demonstration sites, mobile arrangements), timing/schedules, treatment frequencies according to insecticides/formulations.

¨ Net treatment procedures and costs.

6. Existing “formal” structures/networks

Within health (e.g. PHC, MCH/antenatal, EPI, sick child), and outside health (e.g. education, communications/media, water, irrigation, agriculture) and which of these (a) are already involved in ITMN activities, the type of activities and processes, and those efficient and have grass root linkages, and (b) have potential to participate in ITMN activities.

7. Existing “less formal or informal” structures/networks/bodies

Schools, village committees, women's and religious/church groups, NGOs already involved in ITMN activities; their membership, types of activities and processes. Which of these have good, efficient grass root linkages, political strengths; or have potential to do so.

8. Ministries, extension services which work effectively with communities.

9. Knowledge/experiences on women's:

a) status, and social and economic participation in any development activities in the community,

b) influence in the household with decision making implications on net ownership and use at household, payments for nets, insecticide treatment,

c) influence in community-based activities including ITMNs.

10. Socio-cultural, and economic aspects (documented, known or experiences, and through KAP surveys) on:

¨ Estimates on proportion of people using nets;

¨ Type of nets (designs, sizes, materials, colours), preferences and in use;

¨ Net washing habits.

¨ Community perceptions related to malaria, mosquitos, use of mosquito nets and curtains, and on their associations with each other;

¨ Social and economic issues likely to influence ITMN programme including the choice, and use of nets, and affordability of the communities concerned and their perceived benefits of bednets; attitudes, beliefs concerning net use;

¨ Educational and literacy status including of women;

¨ Types of occupations in households at highest malaria risk, their ability to buy nets and pay for insecticide-treatment;

¨ General sleeping habits and movements at night of people of different age groups in relation to, and influencing net use patterns;

¨ People's sensitivity to nuisance from mosquitos, bedbugs, fleas, lice, etc.;

¨ Types of anti-mosquito methods (nets, coils, other repellents) in use, and costs incurred.

Annex 5. Potential sources of information for ITMN programmes

¨ Health services/malaria control programmes;

¨ Non-health sectors (e.g. education, communication/media, agriculture, water and sanitation, industry, and other private sectors;

¨ Tropical diseases, epidemiological or preventive departments;

¨ Research and academic institutes;

¨ Schools, local leaders, households, NGOs, community organizations (women's groups, church/religious groups, village community groups/workers), private sector/companies, other social structures;

¨ International organizations (e.g. WHO);

¨ Development banks;

¨ Findings from special studies/research;

¨ Publications, documents/reports;

¨ Networking programmes (proposed), WHO collaborating centres.

Annex 6. Roles/responsibilities of potential partners

1. National/Central Level

Political commitment.

Establishment of policy frameworks.

Establishment/adjustment of institutional and collaborative frameworks.

Establishment of procurement systems, import duty/tax exemptions for nets, material, and insecticides.

Creation of opportunities to motivate local tailoring of nets.

Participation in the National Coordinating Committee for malaria.

2. Health services/malaria control programme (central level)

Information management systems

¨ Maintain an updated national level information management system.

¨ Maintain global information covering specifications/standards, sources of nets, material, insecticides, equipment, costs, technologies, processes.

¨ Stimulate documentation, dissemination and sharing of ITMN implementation related experiences within and outside the country including WHO.

Standards/guidelines

¨ Establish and ensure adherence to policies, legislations, standards and procedures related to insecticides, nets and insecticide treatment of nets.

¨ Develop, adapt/elaborate global/regional guidelines and training, educational materials to meet the country specific needs, and disseminate to potential users.

Planning

¨ Establish national procurement system for ITMNs, and interact with regional or sub-regional procurement systems (expected to be developed) for speedy procurement of quality assured materials at low costs.

¨ Undertake national/macro-level stratification, define major priority targets (areas, populations) for ITMNs.

¨ Prepare country level plans of action, assess needs to operationalize activities, mobilize and distribute resources.

¨ Make decisions and commitments on ITMN distribution/delivery systems and processes, in consultation with the collaborators.

¨ Define/assign responsibilities and tasks of malaria control services personnel, and other collaborating partners at each level of implementation.

¨ Assign health workers to participate in the insecticide-treatment of nets.

¨ Support district level macro-, micro-level stratification, planning, needs assessments, resource mobilization, and training activities.

¨ Help/organize financial management, revolving fund/cost-recovery systems.

Training

¨ Undertake training and education (mainly of trainers, and district level implementers), and where necessary in collaboration with national academic and research institutes, WHO collaborating centers/networking programmes.

¨ Establish and maintain a national ITMN demonstration centre for training, education, sensitization, and demonstrations and net treatment.

Collaboration/coordination

¨ Participate and collaborate in NCMC activities.

¨ Interact with other promoters and supporters including DSAs and ESAs of ITMN implementation.

¨ Interact, coordinate, influence, or link-up (as relevant) with those who could make commitments, or influence national level financing, policies, legislature.

* Inputs and activities to the country or operational areas through different sources within and outside the country.

* With relevant personnel of other sectors already involved in, or have the potential for ITMN delivery services, or for making decisions and commitments on distribution or delivery systems and processes.

* In KAP surveys, and development and dissemination of IEC messages.

* With district level, in monitoring and evaluations.

Monitoring and evaluation

¨ Select indicators to meet national/local needs, and target objectives.

¨ Monitor, evaluate, supervise.

* Processes, activities, delivery/distribution systems, storage, net-treatment, financial management; and achievements/progress, and impact.

* Maintenance of standards, specifications.

* Coordinating systems.

* District level implementations.

¨ Ensure implementations according to strategy, achievement of objectives and targets, and that the guidelines are followed, and the policies and legislations are adhered to.

¨ Feedback, suggest or guide adjustments, improvements.

¨ Establish, undertake a programme for monitoring vector resistance to pyrethroids, investigate practical implications of resistances in field operational, if necessary in collaboration with other national research/academic institutes, and WHO collaborating centres/networking programme.

Operational research

In collaboration with relevant district level personnel, and academic/research institutes identify, prioritize, promote, support or undertake operational research of immediate relevance to ITMN implementations

3. District level

Many national level activities are also applicable to the district level though some of them only to a limited degree. The primary responsibilities may be:

Planning

¨ Undertake district level macro- and micro-level stratification, target prioritisation, needs assessment including for community-based activities, and prepare district level plans of action.

¨ Mobilise resources if relevant in consultation with the central level.

Information management: collection, use/exchange

¨ Maintain updated district/peripheral level information relevant to guiding, planning, implementation and evaluation.

¨ Collect information on operations, processes, experiences, attitudes/perceptions of communities on implementations, develop and disseminate appropriate IEC messages.

¨ Exchange information with the central, peripheral/community levels.

¨ Feedback for concurrence and advise from the central level, and for remedial actions at peripheral levels.

¨ Make appropriate programme adjustments.

Co-ordination/partnership

¨ Identify and collaborate with district level partners in planning, and resource mobilisation.

¨ Define responsibilities of collaborating partners in consultation with central level management, and with the collaborators.

¨ Interact with health/non-health public sectors, private sector, NGOs to access their networks of delivery services for ITMN delivery, and for collaborative activities.

Training, guidance and education

¨ Adapt national guidelines to district/local-specific needs.

¨ Train district, peripheral level health personnel, and other ITMN collaborators including communities.

¨ Undertake/promote community education and sensitisation activities:

¨ Establish district level ITMN demonstration center(s) for insecticide treatment, training and community sensitisation activities.

Logistics, financing, delivery services

¨ Co-ordinate supply management, storage, distributions.

¨Identify and establish distribution structures, mechanisms, processes (in consultation with central level management).

¨ Prepare and adhere to distribution schedules to ensure material availability at user-levels on time.

¨ Help/guide establishment and management of financing processes (e.g. revolving funds) at the periphery and community levels.

Supervision, monitoring

¨ Supervise district, peripheral and community level activities and processes, e.g. net and insecticide distribution, net (re) treatment, community use of nets, financial management.

¨ Participate in monitoring vector resistance to insecticides, quality assurance of insecticides and their applications; (in collaboration with central level, and academic/research institutes).

¨ Monitor adherence to standards and specifications.

Reporting

¨ Report to national/central level relevant findings (especially of any significance) and achievements/progress, shortcomings.

4. Peripheral/community level

Planning

¨ Participate in the planning/replanning of community activities, if needed with district level inputs.

Information, training, education, sensitisation

¨ Share information with community members and the district level.

¨ Collate information on community perceptions, beliefs, practices, compliance coverage (use, washing, re-treatment).

¨ Contribute to, or participate in the district level development of IEC messages, and in their dissemination including education, and community sensitisation.

Logistics, financing

¨ Ensure/manage logistics at this level.

¨ Establish and manage suitable funding mechanisms, cost-recovery systems for nets, and net-treatment.

Training

¨ Co-ordinate, facilitate or undertake training at local/community levels.

¨Establish local demonstration center for insecticide treatment and training.

Coordination

¨ Co-ordinate and facilitate net distribution, and insecticide (re)treatment.

¨ Interact and collaborate with local level NGOs, community associations, schools, churches/religious centres, commercial outlets, health and non-health networks operating in the areas, on ITMN related activities.

¨ Participate in or undertake monitoring of community level activities.

¨ Feedback to district levels and the community for necessary adjustments.

¨ Promote or organize net sewing by community members/groups.

5. Non-governmental organizations (NGOs)

The responsibilities/contributions vary at different levels depending on the respective strengths. Overall they may:

¨ Participate in respective collaborative committees depending on level of location.

¨ Collaborate with the national level concerning procurements, imports, storage, distribution of nets/insecticides.

¨ Provide financial/logistic support, and help manage community-based actions.

¨ Assist or participate with the health authorities and other public and private sectors/agencies in relevant activities, mainly on service delivery.

¨ Participate in education, and sensitisation of communities.

¨ Contribute to information bases depending on their sources of information, and what they collect.

6. Local community groups

¨ Co-ordinate or undertake storage, and distribution of nets, insecticides, and insecticide-treatment of nets.

¨ Co-ordinate and promote sewing of nets at community level, when applicable.

¨ Undertake financial management e.g. cost-recovery systems/revolving funds.

¨ Monitor community compliance, e.g. net washing practices, use of nets.

¨ Examine community perceptions, beliefs, practices on net, insecticide uses, etc., and influence community towards proper use of treated-nets.

¨ Participate/undertake community educational/sensitisation activities.

¨ Exchange information with the NGOs ate local and district level, and with the community members.

7. Private sector/industry

¨ Contribute to service delivery through own networks of delivery services especially in the reach of populations in remote areas.

¨ Provide relevant co-ordinating committees with information on nets/material, insecticides, their sources, specifications and costs.

¨ Undertake local sewing of nets, production of material for ITMNs at prices and of quality which compete with the imported.

¨ Contribute with financial, logistic support.

8. Individuals/Households at malaria risk (the net-users)

¨ Procure nets.

¨ Pay for insecticide treatment of nets.

¨ Get nets (re)treated on schedule, but wash nets before treatment, avoid frequent washing of treated nets, when washed often get them re-treated.

¨ Ensure proper use of treated nets in the house.

9. Research and academic institutes and scientists

In collaboration with the central and district level malaria and ITMN implementers:

¨ Participate/undertake training, operational research, insecticide resistance monitoring, KAP surveys; checks on bio-efficacy insecticide treated nets, and quality of the insecticide applications.

¨ Contribute to the information systems providing relevant technical information such as on vector behaviour, insecticide susceptibility status.

10. Other Domestic Support Agencies (DSAs), and External Support Agencies (ESAs)

¨ Provide financial, and logistic support.
¨ Participate in relevant activities, e.g. training, development of training and educational materials.
¨ Contribute to development of information systems.

11. Regional, sub-regional networking programmes

¨ Support and co-ordinate:

* Speedy, low cost, quality assured bulk procurement.
* Monitoring of vector resistance, to some extent of nuisance insects.
* Information sharing including on operational and research experiences.
* Training.

Annex 7. Framework for collaborative/partnership planning

PARTNERS/PARTNER INSTITUTES

Activity/Task

Macrolevel decision makers

Health/malaria control staff

Other government sectors

Academic/research institutes

NGOs

Community groups

Private sector

Other support agencies

Political commitment, Institutional set up and characteristics

Establish policy framework









Establish institutional, collaborative framework









Incorporate MC/ITMNs in health systems reform structures









Define & delegate responsibilities









Establish framework to motivate workforce









Establish procurement systems









Planning

Establish target priorities









Prepare plans of action









Make needs assessments









Information, education and communication

Establish/maintain efficient information management system









Convince policy/decision makers, support agencies









Create motivated workforce









Mobilize community









Promote proper use of ITMNs









Technical information and choices

Assess resources, training and research needs









Provide information on materials (sources, specifications, costs, safety) to providers, implementers









Choose insecticide(s), formulations, dosages









Select treatment method(s)









Select monitoring indicators









Establish treatment processes, undertake (re)treatments









Training

Provide training and guidance









Funding

Mobilize funds









Procurement, local manufacture

Make procurements on time









Purchase/sell nets at cost, subsidized









Promote local sewing of nets









Promote local commercial manufacture of nets









Storage and delivery, marketing

Store nets and material properly









Distribute to stores, user levels/treatment sites









Ensure insecticide (re)treatments on schedule









Financing: subsidies, grants, cost recovery

Sale at cost, or subsidized









Provide free (exceptionally)









Provide seed money, other support to community based net delivery systems









Meet costs of (re)treatments free, subsidized, or full cost









Monitoring, evaluation, quality control

Ensure adherence to policies, standards









Ensure proper mixing, dosages, treatment procedures









Ensure quality assurance, treatment efficacy, efficacy on vectors of pyrethroids used,









Undertake vector resistance monitoring









Ensure adherence to net washing requirements, i.e before (re)treatments, not soon after treatments









Ensure proper use of treated-nets









Monitor operational process, activities, target achievements









Assess impact on disease









Operational research

Identify operational research needs









Carry out problem-solving research









Support operational research









Guidelines to country-specific needs

Develop country-specific handbook based on AFR guidelines









Annex 8. Examples of monitoring process targets and monitoring indicators

Process targets

Monitoring indicators

Problem definition

200 000 nets of sizes ..., delivered at each of the 10 districts in Region A before day.... month .... year....

Number of districts out of 10 that received 200 000 nets as scheduled

Not enough nets
Problems of delivery, transport, and personnel

5 million nylon nets of size ...., mesh .... to be imported to country before December 1996

Date of ordering nets
Date of net delivery, or expected at port of entry

Orders made too late
Late manufacture, shipment, arrivals
Delays in clearance

In district A, 5 insecticide treatment centres will be established in 1996 to serve 25 groups of villages (communities) at high malaria risk

Number of treatment centres established in district A in 1996
Number of villages at high risk with access to treatment centres
Of the implementing partners (health, other governmental, social, and NGOs, the proportion received information, training, required skills

Time inadequate to establish all 5
Inadequate trained personnel, supply shortage

Before peak transmission period in 1996, at least 70% of children < 5 years in all 5 communities in ........ will receive treated nets through PHC services

Estimated number of children < 5 in the 5 communities
Number of PHC personnel
Number of children received treated nets

Not enough nets
Treatments delayed or facilities not enough
Inadequate distribution services

In area A, to increase use of treated nets by children < 5 years in at least .... % of the households by January 1997, compared to January 1996

Total number households
Number households where children < 5 years already use treated nets
Number households with children < 5 years, given treated nets
Number of households where children < 5 years sleep under nets provided
Number of nets treated within 6 months of transmission period
Types of IEC messages; how many households were accessed for IEC

Shortage of nets; inadequate treatment facilities; children not given priority; lack, inadequate promotional activities including IEC

In district B, one net treatment centre will be established to serve each group of 5 villages by December 1996

Number of villages in district
Number with and without access to a treatment centre

No resources
No or poor planning

By ...., to increase to ..... % the proportion of households using at least one ITMN

Of the households targeted the proportion with a net per bed and in use
Proportion of targeted households with at least one member aware of ITMNs, their proper use and maintenance


Annex 9. Examples of operational research priorities

¨ Insecticide resistance status of malaria vectors to the insecticides in use, and potential alternatives.

¨ Vector behaviour and response to individual, household, community or village level use of ITMNs.

¨ Interaction of different types of fabrics with different insecticides (active ingredients and solvents); their effect on target vectors, and persistence of insecticides.

¨ Simple tests to quantify insecticide persistence on treated nets.

¨ Safety of insecticides (active ingredients and solvents) to humans on exposure during handling, insecticide-treatment, ITMN uses.

¨ Efficacy, stability of insecticides following storage under different conditions.

¨ Establishment and review of system for delivery of nets, insecticide (re)treatments.

¨ Training, educational and IEC materials for use at central, regional/district, community level and within and outside the public/health services.

¨ Rapid assessment methods for review, KAP before and after ITMN uses.

¨ Insecticide repackaging options.

¨ Duration of efficacy of insecticide-treated surfaces on target and nuisance insects following use, washing, and exposure to smoke, dust.

¨ Impact of IEC, training, and community involvement on communities' perceptions on mosquitos and disease, and knowledge and attitudes to ITMNs in areas with and without net-use habits.

¨ Insecticidal, killing, repellent and knockdown effects of different dosages of insecticides (including sub-lethal dosages on nets, on mosquito longevity, fertility and susceptibility to infection.

¨ Review of sensitivity, specificity, relevance of indicators, and data collection methods in use under different malaria transmission conditions, and in relation to the ITMNs programme objectives.

¨ Effects of ITMNs on malaria pregnancy in primiparous women in different epidemiological conditions.

¨ Major determinants of feasibility and sustainability of ITMN programmes.

¨ Mechanisms for effective integration of ITMNs in NMCPs, and other services within and outside public health services.

¨ Relevance of low dosages of insecticides for (re)treatment to accommodate frequent net washings.


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