Fifth Intercountry Meeting of National Malaria Programme Managers Countries of Moderate to High Mala

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Fifth Inter-country Meeting of National Malaria
Programme ManagersCountries of Moderate to High
Malaria EndemicityCairo, EgyptMay 29-31, 2005

• Update on Scaling-up Insecticide Treated Nets
• Mohammadou Kabir Cham
• Roll Back Malaria Department, Geneva

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Overview of Presentation

• Current situation for ITNs
• Challenges and pending issues
• Next steps

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Recent trends are promising
Source PSI distribution data
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Relatively Recent Coverage Data

• Some countries already succeeded
• Togo gt95
• Eritrea gt60
• Some others are poised to reach the target
• Tanzania
• distributed 2.3 million nets bundled with
  treatment kits and a further 2.5 million
  insecticide retreatment kits (2003)
• currently 7.8 million nets are in use in 7
  million households, 70 of them treated
• Other countries with new programmess, new
  funding, or a rapidly growing culture of net use
  that can be converted to ITNs are within striking
  distance such as
• Senegal, Malawi, Zambia, Uganda, Rwanda, Guinea
  Bissau, The Gambia, Mali, Niger
• But still unlikely most countries can reach 60
  by end of 2005

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Promising Pathways

• Integration of free ITNs or ITN 100 redemption
  vouchers
• with other service delivery points
• Measles malaria (periodic campaigns)
• National immunization days (periodic campaigns)
• Child health days (periodic campaigns)
• EPI (continuous routine distribution)
• ANC (continuous routine distribution)
• Converting huge standing crop of untreated nets
  to LLINs
• Technology suitable for campaigns
• Other targeted subsidies
• Social marketing through health services and
  private providers
• Commercial distribution incentives
• Emergencies

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Potential areas for collaboration during SIAs
Delivery of free treated nets, or vouchers, to
children under 5 years
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Measles Malaria Evaluation Plan
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ITN coverage and equity Pre-and
Post-campaign
HHs with lt5 child All HHs
Coverage, pre 10.0 8.0 Coverage,
post 87.0 62.5 Equity
ratio, pre .25 .25 Equity
ratio, post 1.02
1.02
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Eligible children and households receiving ITNs,
by Region
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Global Fund ITN Projections

• Global Fund allocations in Rounds 1 - 4 can
  support distribution of on average 20 million
  ITNs per year over a five year period

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LLIN manufacturing capacity is catching up to
global demand
Source UNICEF
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The number of countries ordering LLINs has
increased tenfold over past 4 years
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Olyset

• Polyethylene yarn with permethrin incorporated
• Strong netting much more durable than polyester
• Mostly repelling vectors
• Bio-efficacy lasting for at least 5 up to 7 years
• Produced in China and Tanzania - range of sizes,
  colours and shapes
• Price (rectangular) US4.5 to 5.2 per net
• Production capacity increase to 20 million by
  end 2005 from China Tanzania

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PermaNet

• Polyester yarn with deltamethrin coated around
  fibres
• Same life duration as polyester nets
• Effective in killing vectors for up to 20
  standard washes
• Effective duration of biological efficacy in the
  field under investigation
• Available in a range of sizes, shapes and colours
• Produced in Viet Nam and Thailand
• Price (rectangular) US4.3 to 4.7 per net
• Production capacity increase to 30 million by
  end 2005

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Challenges and pending issues
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Forecasting demand for ITNs/LLINs

• Need for timely country level forecasting/
• planning to
• reduce current lead times (6 months)
• match campaign schedules and deadlines
• assure supply matches demand
• have buffer stocks of LLINs to compensate for
  routine demand

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ITN scale-up challenges

• National-scale delivery mechanisms
• comparative in differing systems not yet known
• need to learn systematically from on-going
  experiences
• tendering procurement procedures for
  large-scale operations still slow
• country generated and adapted solutions sometimes
  overlooked
• increasing tendency towards external imposition,
  single solutions and one-size-fits-all
• major advocacy/communication gaps much
  misinformation

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Next steps
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Next Steps

• Operational framework and guidelines on
  integrated approach
• Linking ITN deployment with other health
  programmes
• Integrated demand and supply forecasting
• Specifications on LLINs
• Long lasting treatments
• Other LLIN applications

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