continuous distribution strategies to sustain universal coverage with llin nasarawa community...
TRANSCRIPT
Continuous Distribution Strategies to Sustain Universal
Coverage with LLIN
Nasarawa Community DistributionPreliminary Results
This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the presenter and do not necessarily reflect the views of USAID or the United States Government.
Objectives of Evaluation
• To assess the level of net and LLIN ownership in households comparing different channels of distribution
• To assess the use of nets in general and LLIN in particular by different population groups
Primary
Objectives of Evaluation
• Measure the equity in access to nets from various sources
• Obtain detailed information about net use and sleeping patterns in the family
• Evaluate the success of the IEC and BCC activities associated with the program
Secondary
Community-based Distributions
• Depends on families taking initiative to request new LLIN• Community-agent s trained for NTD MDA serve as a link to
verify need and issue coupon• Hubs to give out nets are health facilities
4
Evaluation Surveys
• Population representative household surveys with cluster-sampling design
• Sample size 1020 households (60 clusters, 17 hh)• Before-after comparison between baseline and
endline surveys
5
Results
Household characteristics
Demographics
Indicator Baseline Endline
Households in sample 1015 1003
Mean # of persons/household 5.0 5.0
% of population U5 13.3% 15.6%
Households with any U5 47.1% 55.4%
Households headed by females 24.8% 18.5%
Households polygamous 49.8% 32.0%
Mean age of head of household 40.7 38.2
Household Assets
Indicator Baseline Endline
Has radio 79.2% 72.8%
Has TV 41.0% 40.8%
Has mobile phone 61.0% 65.8%
Has any transport 70.4% 73.9%
Has fridge 10.3% 13.5%
Owns land 79.0% 75.1%
Results
Access to new nets
Nets obtained after campaign
All households If got any new netsFacility + CDD 18.5% Facility + CDD 68.5%
Who got new nets• Access to new nets did not differ by rural/urban, family size or wealth
quintile• But was much higher among households who also reported having
received an campaign net
Who got nets from where
If household got any new nets
CD Channels Commercial or Family
Results
CDD implementation
Awareness of CDD Program• Only 32.2% of households in Nasarawa knew about CDD program• This did not differ between wards with or without distribution point• But was higher in urban communities
CDD Program Effectiveness• All sampled households
Program Effectiveness• Households aware of CDD program
92% CDD ran out of coupons
46% no nets in stock49% too far to walk
Program Effectiveness• Reasons for not requesting nets from CDD if aware of CDD program
Reason for new nets if requested:81% never got nets10% don’t have enough 9% replacing old nets
Results
ITN ownership
Net output
Indicator Value
LLIN delivered to State for CD 245,850
Estimated LLIN distributed through facilities 49,419
Estimated LLIN distributed through CDD 32,005
Estimated LLIN distributed through ANC 20,709
Total distributed through CD 102,132
Distributed as % of delivered 41.5%
Distributed as % of annual need for UC 27%
Trend in ITN Ownership
Campaign CDD
ANC
Trend in UC indicators
Impact of CDD DistributionComparing households aware of CDD program with
others
Intra-Household Supply with ITN
Results
Equity
Equity of ownership
Any ITN Endline: source of new net
Equity of ownership
Any CD Any CDD
ResultsKnowledge, Attitudes,
Perceptions
Exposure to Messages on Nets
Any message heard Source if any message heard
Recall of Messages
If any message heard
Impact of BCC
Discussed net use in family Intent to use every/most nights
• Exposure to messages leads to discussion of net use in family which leads to intention to use frequently
Impact of BCC• Among households aware of the CDD program those very confident
to take action regarding nets were much more likely to get nets from the CDD/HF pull system
Results
ITN use
Surveys in Relation to Rains
The Use GapAccess vs. use
Use at Population LevelOnly Households with 1 ITN / 2 people
Who used which ITNOnly Endline Survey
Conclusions• In principle, the continuous distribution
achieved a significant impact on ITN ownership whithout oversupplying
• Distribution channels were largely complementary with very little overlap
• However, implementation was done very late and at an insufficient level of efficiency (low awareness, stock-outs of coupons and nets)
• This resulted in not sustaining campaign results and continued drop in UC
Conclusions (2)• In a pull system like the CDD program, a
strong household confidence to take action to get nets is critical and BCC must be structured accordingly
• Special attempts must be made to reach and involve the poorest wealth quintile
• Although ITN use was generally lower in the dry season, under 5 use was high even then