Abstract
BackgroundIn Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda.MethodsHousehold surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used.ResultsAfter 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani.ConclusionsTargeted campaigns and routine ANC services can both achieve high LLIN retention and use among the target population. The comparatively higher economic cost of delivery through ANC facilities was at least partially due to the relatively short time this system had been in existence. Further studies comparing the cost of well-established ANC delivery with LLIN campaigns and other delivery channels are thus encouraged.
Highlights
In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services
The major difference between the two distribution channels was that 9.8% of sampled recipients from the ANC distribution were unknown in the community while all LLIN recipients from campaigns were verified as residents
The Roll Back Malaria (RBM) Partnership aims at 80% use of insecticide-treated nets (ITN) and other appropriate vector control methods by 2010 [3]
Summary
In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. Regular use of long-lasting insecticidal nets (LLINs) is one of the most effective ways of preventing malaria infection [1] This and other evidence has resulted in a considerable increase in funding for malaria control, and for LLINs in particular [2]. In an attempt to address these two priorities, some countries, including Uganda, have adopted a "mixed-model" approach Under this model, campaigns are used to rapidly increase coverage, while routine delivery (for example to target groups through health facilities) and the commercial sector are expected to maintain coverage [7]. Where different delivery sectors (public, mixed public private, private and community-based) and delivery channels (routine service, campaigns, vouchers, etc.) have been compared, it was reported that integration into vaccination campaigns seemed the most efficient way to increase coverage, while other approaches were as or more cost-effective and seemed better suited to sustaining coverage [9]
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