When to stop giving?

19 June, 2008

“Demand for mosquito nets soars” Amref began handing out anti-malarial bed nets at the end of May. Now it says demand from expectant mothers for more nets is soaring” This is the June 17th headline on the Guardian Katine website

Since late May AMREF have distributed 500 treated bednets, via the Tiriri Health Centre. But, I have also read that there are an estimated 30,000 people in Katine sub-county. So what is happening?

In the AMREF report on the baseline household survey it was reported that:

“To reduce malaria-related morbidity and mortality, particularly among young children and pregnant women, long-lasting insecticide-treated nets are currently being distributed free by the MOH and partners in antenatal care clinics and communities as part of the National Malaria Control Program. The nets are also available in the private sector. The survey collected information on household ownership of any mosquito (not whether the net was insecticide-treated or long-lasting net), the number of nets owned, the source of the nets, and who in the household slept under them the previous night.

Seven out of ten households (71%) own one or more mosquito nets. Households in Katine/Ojama had the highest coverage of net ownership while the proportion in Olwelai is below the programme average, indicating this is a priority area for intervention in the parish.”

Three out of four mosquito nets (76%) were purchased from the market; health facilities provided 9 percent of household nets (presumably through antenatal care clinics as part of the prevention of malaria in pregnancy program), NGOs provided 14 percent, and VHTs only 1 percent.

Overall, 48 percent of children under five, and 56 percent of women age 15-49, slept under a mosquito net the previous night. The highest proportion of women and children sleeping under a net was in Katine/Ojama and the lowest in Olwelai.

There are a number of evaluation questions that will be useful to ask about this project activity:

  1. Revelance: Why is AMREF distributing these bednets, if the MoH is already doing this? And if “Three out of four mosquito nets (76%) were purchased from the market”?
  2. Equity: Given that the baseline survey has identified that some areas are more in need of bednets than others, to what extent is the distribution process through the Tiriri health centre meeting the needs of those areas? Especially when it has been decided (for equity reasons?) to provide bednets to all who attend Tiriri health centre, including those from other sub-counties. Is there not a better means of targeting this assistance? Such as through the relevant Village Health Teams?
  3. Sustainability: Is this distribution process to be continued, and if so, how will it be sustained? If not, what is its short term purpose? . Are there any some justifiable longer term effects?
  4. Efficiency: The more bednets that are purchased at one time, the cheaper they are likely to be. Presumably the MoH buys bednets in very large volumes. Is AMREF able to buy them cheaper than the MoH, perhaps because they also buy them for programs elsewhere in Ghana, and beyond?
  5. Effectiveness: There has been a lot of research done across a range of countries in Africa on the efficacy of bednets and the best way to promote their use. Their efficacy does not seem to be in doubt. But what has AMREF learned from elsewhere on the best ways to promote their uptake, and how is this influencing the way they are approaching this challenge in Uganda?
  6. Transparency: How is the Tiriri health centre making the availability of bednets known to the public at large? And are they keeping a record of who received the bednets?

I am less concerned about the remaining evaluation question regarding impact, since the efficacy of treated bednets seems to be well established.

PS (21 July 2008): I have just started reading the recently received 6 month progress report on the Katine Partnerships Project.  In that report they note that by the end of March mosquito nets had been distributed to 1308 households with children under five, out of a target of 3250 for the year

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