Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania

Abstract

Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009-2011 and 2015-2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per person-year of protection (including the net). ITN access and use were maintained at a high level (~ 50-75%) over the first 4 years of distribution within selected evaluation areas, even in the absence of a mass distribution event. Net distribution through primary schools has proven to be a feasible and effective strategy for maintaining consistently high coverage in Tanzania.

Keywords: Bed nets; Continuous distribution; Long lasting insecticide treated bed nets; Malaria; Schools.

Fig. 1

Timeline of LLIN distribution in mainland Tanzania from 2004 through 2018

Fig. 2

Map of SNP implementation areas

Fig. 3

Projections for the combination of TNVS and school voucher distribution [12]. The years 2009–2011 show a rapid increase in use due to the modelled effect of the mass distribution carried out in that period

Fig. 4

Household ownership of one (any bed net and LLIN), one LLIN per two persons, and population access to LLIN as measured in four household surveys. Non-SNP Evaluation estimates represent samples in areas with no SNP before the first three surveys (but a mass coverage campaign between survey rounds 2 & 3), while SNP Evaluation Districts estimates represent areas with full SNP rounds implemented prior to each survey. Dashed lines show time periods within the non-SNP evaluation districts prior to roll out of SNP in these districts

Fig. 5

Observed ITN use vs projected ITN use from original NetCALC Model [12] (Stuck pers. commun.). Dotted red lines shows non-SNP districts before SNP was expanded to include them. A mass campaign was conducted in the non-SNP areas between Survey Rounds 2 and 3