Malaria in Communities: Achieving, Tracking, and Maintaining High ITN Coverage

This 6-page brief shares the experience of the Malaria Communities Program (MCP) to increase insecticide-treated nets (ITNs) coverage for malaria prevention. Launched in December 2006, MCP granted 20 awards to 18 partners in 12 countries, to support communities and non-governmental organisations to combat malaria at the local level. This case study presents results from MCP projects working to increase insecticide-treated nets (ITNs) coverage and examines the work of seven MCP partners and their contributions: EQUIP Liberia, WellShare International Uganda, Aga Khan Foundation (AKF)/Progresso Mozambique, Caritas Senegal, Episcopal Relief and Development (ERD) Ghana, Ajuda de Desenvolvimento de Povo para Povo em (ADPP) Angola, and Episcopal Relief and Development (ERD) Angola.

The case study explains that "the global malaria community's three key goals for insecticide-treated nets (ITNs) are achieving universal coverage, sustaining universal coverage, and ensuring proper net use." In order to achieve this, countries need regular, ongoing distribution systems, complemented by behaviour change communication (BCC), to ensure that people are using ITNs consistently and correctly. According to the brief, MCP partners successfully "increased access to ITNs; monitored and tracked ITN ownership and use; increased proper use of ITNs; and identified and addressed challenges to ITN procurement, distribution, and use." This was accomplished through advocacy, supporting community distribution, monitoring, and data management, and increasing communications and messaging around malaria.

MCP partners used behaviour change communication (BCC) to influence knowledge, attitudes, and behaviours related to net use. This included using radio programming, distribution of posters and informational leaflets, and interpersonal communication, particularly through household visits by community health workers and engaging with village leaders. Many distribution campaigns were accompanied by door to door distribution in which community volunteers assist the family to hang the net correctly, and discussed the importance of consistent use. Some partners also used strategies to increase social pressure, for example against using bednets for fishing.

The following key messages were identified (excerpted from the brief):

• "MCP partners facilitated dialogue between community leaders and facilities to prioritise procurement and distribution of key commodities - Though procurement of medicines and supplies is not in the control of communities, dialogue between community leaders and facilities can prioritise key products, including ITNs and sulfadoxine-pyrimethamine for antenatal visits, for procurement.
• Community-level efforts contributed to achieving high coverage and use - MCP partners demonstrated the value of community-level strategies to distribute nets. Strategies included using volunteers and doing door-to-door distribution; community BCC focused on proper net hang-up and use; and net quantification and monitoring from which data were used to procure sufficient quantities of nets, plan for net replacement, and appropriately target net distribution. The success in project areas that utilised community-level strategies underscores the need for continued partnership between national-level stakeholders like NMCPs and community-level facilitators like NGOs.
• Maintaining high ITN coverage and use required consistent monitoring and follow-up - MCP partners found that routine monitoring of household use was critical to meet the PMI's objective of maintaining universal coverage. Addressing barriers to use, replacing/repairing damaged nets, gathering data for ongoing net requirements, and assessing net lifespan were all vital contributions of MCP partners as they worked to achieve and maintain ITN coverage."