LLIN Continuous distribution
through community channels in
Nigeria
Godwin Aidenagbon - MAPS
Emmanuel Obi – NetWorks
16 October, 2013
Presentation Outline
• Background/overview
• Conceptual basis for a community distribution
system
• Designs of community-drive continuous LLIN
distribution
• Procedures for delivery of LLINs through
community channels e.g CDDs
• Issues to consider in scale up
• Future plans
Background/Overview
• The objective of continuous LLIN distribution is to
sustain universal coverage (UC)
• The family typically determines how LLINs will be
utilized within the household
• The key is to make sure there are sufficient LLINs to
cover all household members at any given time
• Multiple channels will be required to sustain UC; one
type of channel is the use of community drug
distributors
• NetCALC can be used to project effectiveness of
various channels, based on data and tailored to
states’ situation.
• Different states will have different strategies based
on state context
Conceptual basis for a community LLIN
distribution system
• There is overwhelming evidence that the communal life in
Nigerian society engenders a strong spirit of volunteerism.
• Volunteers are selected by the community and they are
willing to sacrifice their time and resources to promote the
good of the community.
• Volunteers play in key role in community development and
several health programs in the past have used community
structures to promote access to key interventions. Examples
in Nigeria include the Oncho program among others.
• Volunteers work for the good of the community and are not
directly remunerated for the services provided.
• There is community recognition for the services provided by
community volunteers to the community.
Conceptual basis for a community LLIN distribution
system contd..
 Families are proactive and initiate the process of
getting LLINs; this may make them more likely to
use them (pull strategy)
 Continuous distributions provide multiple
opportunities per year even if one of them is
missed for some reason
 Allows a phased-in approach to first fill gaps left by
the campaign and then attend to replacements
 Existing community structures to increase
awareness about the availability of nets through
the CDD-ANC system and generate demand
1. Nasarawa Design: ANC + CDD
Monthly/Quarterly
Monthly/Quarterly
Verify, give LLIN Slip
HH
Request
Deliver
CDD
Receives Mother’s card at ANC
PW
Receives LLIN at 1st ANC visit
Hub
State,
LGA
2. Zamfara design: ANC + CDD/WDCs (modified)
Community component
Procedure for delivery of LLINs through
community channels
• There are 5 CDDs in each of the wards of the state (4
wards per LGA).
• The CDDs have been trained on how to support
households to access LLINs.
• Based on information provided by LGA RBM & LIHT to
CDDs and WDCs, a request for a net is initiated by a
household member.
• The request shall be communicated by the household
member to a CDD, who will proceed to conduct a need
assessment for the household.
• If the CDD is satisfied that the eligibility criteria has been
met, he/she will issues net SLIPs based on gap to the
potential beneficiary.
Procedure for delivery of LLINs through community
channels contd…
• The potential beneficiary presents SLIP(s) at designated
facility and retains 1 (for sake of verification)
• Health worker keeps 1 Slip and issues 1 net to beneficiary.
• Beneficiary takes net home and hangs for use.
• Health worker files redeemed slip
• Health worker enters data from the slip into the facility
register.
• He regularly reconciles SLIP with register for
accountability purposes.
• LGA RBM FP collates data from all facilities and reconciles
data with LIHT (LGA Integrated Health Team)
• CDD pays visit to the household to ensure hanging and use
of the net as well as addressing issues relating to net use.
Issues to consider in scale up
 Eligibility criteria
o issuance of nets according to identified gap
 Logistics
o continuos availability of LLINs and materials in sufficient quantities
 Consideration for motivation
o WDCs ensure community recognition, including job aids
o some transport allowance when then attend meetings
 Acceptability of the strategy
o Sensitization and involvement will be crucial at all levels stakeholders/community mobilization
 Strong monitoring and supervision component
o Quarterly intensive monitoring and supportive supervisory visits
o Avoiding high attrition rates for CDDs, for good performance
o In-process monitoring and primary output data
Community mobilization for CDD-based strategy
Ward DC
Community
Ward informs HH
HF / Store
HH can complain
Select CDD
HH receives net
CDD
HH requests
CDD assess
HH participate in selection
HH can complain
Sensitize
BCC
Taking community distribution to
scale in MAPS states
• Lessons learnt from the Nasarawa CDD system have
carefully guided the process of roll out of community
distribution of LLINs in Zamfara and Ebonyi state.
• CDD selection is now tilted in favour of volunteers
who have an existing vocation. This will reduce CDD
attrition.
• CDD visibility is enhanced with branded kits.
• Consistency in procedure(s) for service delivery and
messaging is enhanced by a CDD job aid.
• CDD have also been trained to carry out community
mobilization activities as their community activity
Taking community distribution to scale in MAPS states
contd…
• CDDs have been integrated into MAPS existing
community BCC structures. This has provided
additional support to ease the work of the CDDs
– Ward development committees
– Community volunteers carrying out other malaria
control tasks beyond LLINs
– Community mobilizers
– MAPS CBO sub grantees
• Improving data management and coordination
by having
• Monthly State and LGA RBM-CDI meeting
• Quarterly State and LGA CDD-based review meeting
with key stakeholders at both levels
Plans in FY14
 Continue implementing and monitoring Nasarawa
and Zamfara programs
 Nasarawa state program will be evaluated in 2014
and results about the effectiveness of CDD will be
available in August 2014
 Evaluate different types of continuous distribution
approaches. (Results available in 2014)
 http://www.k4health.org/toolkits/continuousdistribution-malaria => contains resources for
continuous distribution