continuous distribution strategies to sustain universal coverage with llin nasarawa community...

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