POST 00763E : MEASLES CAMPAIGN AND ITN DISTRIBUTION

POST 00763E : MEASLES CAMPAIGN AND ITN DISTRIBUTION 16 March 2005 _____________________________________ We start publishing a discussion between colleagues and some malaria experts that has been taking place since the last few months. We hope that more contributions will be made to the debate that starts by a message from Michael Macdonald (mailto:[email protected]) sent to Robert Steinglass (mailto:[email protected]). Follows a message from Robert. The subject line of all messages exchanged was "What do the malaria experts have to say about mass distribution of ITNs through measles SIAs?" Michael's message contains a number of acronyms and we apologize if members are unfamiliar with them. Those interested in reading the most recent update on long-lasting insecticidal nets can access it at : http://rbm.who.int/docs/UpdateLLIN_5.pdf _____________________________________ Hello Robert January 05 Thanks for forwarding the email from Gerhard Hesse from BAYER; we know each other well. The launch of their new "Long-lasting treatment" is welcomed. The BAYER product is using the chemical 'deltamethrin' plus a binding agent - this is the same active ingredient in the Vestegaard-Frandsen "Permanet". The two other large producers of insecticides for mosquito nets, Syngenta (who make lambda-cyhalothrin, or "ICON") and BASF (who make alphacypermethrin, or "Fendona") are also making long-lasting formulations. So we hope that within the next year we will have three "long-lasting field treatments" in addition to the two factory-pretreated brands - the Vestegaard-Frandsen "Permanet" and the Sumitomo "Olyset" net. The expanding technology will help in at least four ways. First, it will help us deal with all those "conventional" nets that were not one of the two factory pre-treated ITNs (the Olyset and the Permanet). Second, it will relieve a severe supply shortage - there is a 9 month waiting list for on orders for the "Permanet", and there is still not a lot of confidence in the community acceptability of the "Olyset" net. Third, and in the longer term - long lasting field treatments will allow more quality net manufacturers to remain in business, and not lose out on all the tenders for long-lasting nets to Vestegaard. Finally, and most relevant to the measles/malaria debate, it allows provides more value to existing systems and nets that are already in the community. I remain strongly against the idea of blitz ITN distributions. The arguments that NIDs undermine immunization programs goes double for malaria programs, where targeting is important and continue follow-up essential. In the end, dumping nets through an immunization campaign does more harm than good. There are various distribution channels here in Zambia. The country is committed to a sustainable and equitable ITN program, and to that end, strives for market segmentation - that we can maintain a sustainable supply of ITNs and at the same time make them available at reduced cost or free to those who most need them. The country has made considerable gains in building systems for subsidized and free ITNs. For the subsidized nets, Exxon-Mobil last week donated $80,000 for the NetMark voucher program, - a strategy that will both make delivery of ITNs at logistics cost to the public health system, and stimulate a commercial market for ITNs. In areas with a less vibrant commercial market, the national program is working with partners (including PSI) to deliver subsidized ITNs through Ante-natal Clinics, Community Health Agents and NGOs. There has also been a rapid expansion of systems for delivering free ITNs.The national program has begun to work with the HIV Home-based Care programs, including the Catholic Diocese, CRS, and the numerous NGOs supported through the new USAID 'RAPIDS' project and PEPFAR. The policy is that every person living with HIV and AIDS should have an ITN. Zambia has dozens of organizations involved with PLWHA and OVCs who are receiving free nets from UNICEF and the National Malaria Program for distribution to their target populations. Much of this is being coordinated through the 'Zambia Malaria Foundation" which is an outgrowth of the original CORE - NGO Malaria Secretariat. Putting the ITNs through these existing systems is slower than a one-week distribution campaign. However, it empowers the CBO delivering the ITN to continue follow-up with the recipient household and ensures that the ITN will be used properly and not just taken by dad, sold, used for fishing, or folded away. We do joint campaigns with EPI for ITN retreatment during child health week in June and December. Here we use both static health posts, where mothers who bring their children for Vit A, deworming and immunization also bring nets for free retreatment. We also support door-to-door retreatments through community agents, boy scouts/girl guides, and other volunteer service organizations. The value of these retreatment campaigns will be greatly increased when we begin to use the KO-Tab 123 and other long-lasting net retreatments. (This will also remove the argument that we can only supply Permanets through these campaigns). These systems for ITN delivery and retreatment are working and are sustainable. Those that favor the blitz strategy of dumping nets during the measles vaccination campaigns say that we are not attaining coverage quickly enough to meet the "Abuja Targets". That may be true, but I like to say that Zambia will attain, "and sustain" these targets by building the system, long after the campaigners have departed. Abuja is a marathon, not a sprint. Finally, claims that ITN dumps during immunization campaigns are more 'cost-effective' than routine systems in terms of "cost per net delivered" are dubious. First, ITNs in the routine system are targeted and followed up, and not just given indiscriminatingly, to houses that already have them, can afford to buy them, or who don't use them properly. Second, we are trying to build an integrated service delivery system, which includes not just ITN delivery, but maternal/child health, and now, home-based care for PLWHA and OVCs. Putting the ITNs through existing systems achieves a greater good than just 'the cost per net delivered' through a campaign. In summary, we have the systems to sustainably and equitably deliver ITNs that should be supported, and not undermined, by untargeted, one-off, dumps during immunization campaigns. Robert, I am sure these are the same arguments you use for building routine immunization programs. Building routine systems may not provide the same photo-opportunities for the donors, but will be there when their attention moves on. Let us join EPI for net retreatments, but not for delivery of the nets themselves. Good Luck! Michael --------------------------------------- Michael Macdonald is a well-known and highly-regarded malaria expert based in Zambia. I firmly believe that there should be a vigorous debate about ITN distribution during SIAs among malaria and immunization experts, including some of the anticipated negative consequences of mass distribution. I had asked him for his views in the hopes that some of them would be raised at the recent Measles Partnership meeting, which I was unable to attend this year due to duty travel. Robert Steinglass Technical Director IMMUNIZATION Basics ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. 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