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As part of its mandate of Local Fund Agent (LFA) for the Global Fund against AIDS, Tuberculosis and Malaria (GFATM), SCIH is responsible for monitoring and evaluating malaria programs. Besides aspects such as the introduction of ACT based treatments, bed net distribution represents usually a significant part of the activities and of the budget. As LFA, SCIH is involved along the whole process, from budget validation to procurement, distribution of bed nets, and finally reporting of results to the GFATM. The LFA controls that the whole process is conducted in a satisfactory and transparent manner, monitors the regular progress of procurement and distribution activities. Once a year, the LFA conducts data on-site verifications to verify the reporting system in place in the countries.
Malaria is endemic in Niger and Senegal and remains a main cause of mortality and morbidity. The use of Impregnated Treated Nets (ITNs) for the prevention of malaria is a key element of both countries’ strategic plans to fight malaria. However, the two countries have adopted a different approach in terms of bed nets distribution. They both decided to use Long Lasting Impregnated Net (LLINs). While in Niger only LLINs were procured, Senegal had to purchase both LLINs and non-impregnated bed nets with impregnation kits, as there was a lack of LLINs on the market.
In Niger, procurement and distribution used two different channels:
a distribution campaign integrated with the immunization campaign:2.2 millions LLINs were distributed free of charge to pregnant mothers and children under 5 under the malaria round 4 grant in 2005 a distribution channel through the National Malaria Program offering LLINS for 500 CFA, for a total quantity of 300’000 LLIN’s under the malaria round 3 grant in 2004
In Senegal, 80% of all bed nets are distributed through the public health system:
Since 2005, more than 1.1 million bed nets have been purchased by the National Malaria Control Program under the malaria round 4 grant and around 450’000 bed nets have been distributed so far. Bed nets are distributed by national pharmaceutical stores to the districts and then sold by health centers and community-based organizations. They are sold at a subsidized price of 2000 CFA. Pregnant women and children under 5 are targeted at the occasion of prenatal consultations and child immunization visits, and receive vouchers allowing them to benefit from a preferential price of 1’000 CFA. Another 15% of all bed nets are distributed through the private sector, while the remaining 5% is being donated by NGOs.
In Niger from 2005 until today, the percentage of households owning at least one bed net has increased from 28% to 86%, while the percentage of pregnant women sleeping under ITN went from 27% to 40% and the percentage of children under five sleeping under ITN increased from 21% to more than 52.4%. Nearly all GFATM intended targets were reached.
In Senegal the household coverage has increased from 40% in 2003 to 60% in 2006. As a result, the use of ITNs among vulnerable population has progressed but is still behind the targets set by the Global Fund supported programs. The usage rates among pregnant women and children under five were respectively 33% and 46% at the end of 2006, compared to a target of 60% for both vulnerable groups.
The main issues in scaling up access to ITNs were:
- international procurement delays
- difficulty of in-country distribution
- difficulty to reach the most isolated populations
- weaknesses of the information and reporting system
- affordability of the ITNs for the poorest populations
- insufficient promotion of bed nets use in Senegal.
Dominique Guinot
Bruno Clary
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