Improving quality through process assessments during mass distribution campaigns of Long Lasting Insecticidal Nets (LLINs) in Nigeria: Studies from four states

Abstract

Background:Mass distribution campaigns of long lasting insecticidal nets (LLINs) have been adopted by the Nigerian National Malaria Elimination Programme as one of the key strategies to rapidly scale up LLIN ownership and use for malaria prevention. The success of mass campaigns are measured against certain output targets, which include net slip redemption, LLIN household retention rates and proportion of targeted versus actual population reached with LLINs. Process assessments are useful for providing immediate feedback for the implementation processes, resolving implementation bottlenecks as well as for planning and implementing campaign ‘follow up’ activities. This study is an attempt to find out the effects of process assessments on mass distribution campaign outputs. Methods & Materials: The study monitored the outputs from mass distribution campaigns in two states in Nigeria supported by the PMI/MAPS project using a comprehensive package of process assessments and compared these against 2 other states which implemented LLIN distribution activities following the national campaign guidelines. The assessments conducted in the 2 MAPSsupported states involved in-process and end-process assessments as well as LLIN tracking using a customized excel template to capture the status of LLINs spatially and temporally. Key output compared across the study states included, distribution data by distribution points, number of LLINs left undistributed at the end of the distribution period and number of additional nets distributed during the campaign followup period. Results: High net redemption rates were observed with wellimplemented process assessments (90% and over) compared to 70%-80% in the 2 non supported states. Other pluses included the reduction of undistributed nets after the campaign and completeness of campaign data reporting. Conclusion: The result is significant for the planned repeat LLIN campaigns in about 11 states in Nigeria where LLINs have reached their normal end of life (EOL). Well implemented process assessments will help to ensure high distribution rates (with direct effect on population coverage) and thus provide a solid foundation for continuous LLIN distribution during the covergae keep up phase.