Intercountry workshop on scalingup ITN implementation for the control of malaria and other vectorbor

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Inter-country workshop on scaling-up ITN
implementation for the control of malaria and
other vector-borne diseases in countries of
EMRAbha, Saudi Arabia, 18-20 October, 2003

• Monitoring access and utilization of ITNs
• The key to results-based programming
• Ms Asiya Odugleh/ Dr Will Parks
• WHO Mediterranean Centre for Vulnerability
  Reduction (WMC)

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Purpose of this presentation

• To reinforce the significance of programme
  monitoring in access and utilization of ITNs
• To identify key areas that will lead to better
  programme monitoring in access and utilization of
  ITNs
• To give a practical example of how programme
  monitoring can be applied and adapted for EMRO
  countries (Sudan)
• NOT to compare and contrast different
  methodologies or research techniques

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Background to this presentation

• Situation Malaria is still a major public health
  problem and ITNs programmes are central to RBM
  strategies to control and prevent malaria
• Issue The success of national programmes is
  dependent on ensuring wide access and promoting
  appropriate use of ITNs by households
• Question How can we ensure that ITN programmes
  are working and ultimately delivering results?

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Outline of this presentation
Key implementation
challenges
Applying
programme monitoring
Sudan
The significance of programme monitoring

• Helps decision making
• Specific purpose
• Focuses priorities

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Programme monitoring helps decision making
Significance

• Applies social research to judge and improve
  programmes
• Results inform programme management, strategic
  planning and resource allocations
• Critical for scaling up

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Programme monitoring has a specific purpose
Significance

• Programme monitoring has two main purposes
• To improve programmes by identifying those
  aspects that are working according to plan and
  those that are in need of mid-course corrections,
  and
• To track (and demonstrate) results at the
  programme or population level

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Programme monitoring is a type of evaluation
Significance
Monitoring Programme Performance
Assessing Impact
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Outline of this presentation
Key implementation
challenges
Applying
programme monitoring
Sudan
The significance of programme monitoring

• Plan monitoring early
• Focus on behaviours
• Define appropriate indicators and
• sources of data

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Sudans malaria contribution
Application

• To EMR
• Half of all malaria cases
• Nearly ¾ of all malaria deaths
• To its national health service
• More than a third of all out-patient attendances
• Up to one third of the annual in-patient
  attendance
• To its national economy
• Malaria accounts for one fifth of working days
  lost
• People spend between 5.2 17.2 on malaria

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Sudans ITN status
Application
Net ownership and use
Malaria impact
Challenge
It will take 37 years before there are enough
ITNs for the most vulnerable groups

• Nets only used by 4 of communities (26 states)
• 7 owned a net in North
• 52 owned a net, 21 owned an ITN
• 20 of children slept under a bed net night
  before the interview
• 10 slept under a bed net the previous night
• Low re-treatment rates

A young child dies every 15 minutes Someone
falls sick every 8 seconds
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Malaria Free Initiative interventions work
Application
Reported malaria cases have gone down
Burden Malaria cases as reported from health
facilities, Sudan, 1997 -2003
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Application
Deaths due to malaria have gone down in project
areas
Malaria deaths after launching of malaria
mortality reduction project in Kosti Hospital,
Aug 2002--March 2003
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How do we know what was done to plan, how well it
was done, what was changed?
Application
To scale up.
?
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Key Behaviours Get bednets, Use bednets,
Re-treat bednets
Application
Services must be easily accessible and available
New habits must be encouraged particularly for
vulnerable groups

• ACCESS
• Purchase ITNs
• Retreat ITNs

• USAGE
• Consistently sleep
• under ITNs
• Handle and
• store appropriately

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Communication-for-Behavioural-Impact (COMBI)
Application

• Behaviourally focused social mobilization
• Systematically applies a blend of communication
  actions
• Administrative mobilization
• Community mobilization
• Personal selling (interpersonal
  communication/counselling)
• Advertising
• Point-of-Service Promotion

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1) Plan early and operationalize purpose
objectives it takes the pain out of knowing what
to monitor later
Application
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In turn it takes the pain out of formulating
outputs
Application
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In turn it takes the pain out of formulating
outputs
Application
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and outcomes
Application
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2) Link objectives to indicators
Application

• Indicators are variables that measure different
  aspects of a
• programme
• Inputs
• Processes
• Outputs
• Outcomes

• Identify the key question(s) to address and
• match with appropriate indicators
• Define indicators in clear, precise terms

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3) Link objectives, indicators, and sources
of data
Application
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Outline of this presentation
Key implementation
challenges
Applying
programme monitoring
Sudan
The significance of programme monitoring

• Co-ordination
• Management
• Resources

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Coordination is essential across disciplines and
between actions
COORDINATION BETWEEN ACTIONS
COORDINATION BETWEEN MULTI-DISCIPLINARY TEAMS
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Implementation demands on-going management and
resources

• Regular progress checks
• Vigorous follow-up
• Funds (staff time, transport, administration)

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In summary
Implementation must be
progressive and sustained
Applying it well is
dependent on finding answers to the
right questions at the right time
in the right way
Programme monitoring is critical to
understanding performance and demonstrating
results
The growing complexities and demands on ITN
programmes to scale up require the strategic
application of many disciplines. Good planning
and monitoring will help focus priorities, use
resources more effectively and make it easier to
show results.
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Next steps

• Review monitoring component of your ITN strategy
• Decide what needs to be improved
• Develop an ITN monitoring plan use chapter 3 of
  the ITN
• manual for national programme managers and
  the handouts

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Finally.

• If you are interested in developing a COMBI Plan
  for your
• own programme
• Speak to Hoda and Abraham!!!