Abstract
BackgroundThe Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E).MethodsA comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme.ResultsThe evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time.ConclusionThe M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.
Highlights
The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women
Both meetings included stakeholders from the National Malaria Control Programme, groups involved in implementing ITN activities in Tanzania, and researchers
Measuring health impact was beyond the scope of the resources available; the health impact of ITN use on morbidity, mortality and anaemia had been demonstrated under effectiveness conditions in an earlier study in Tanzania[2,4,6]
Summary
The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E). While high levels of coverage have sometimes been reached, it is not clear that the same results can be achieved when the same delivery model is expanded to national scale, due to issues of managerial capacity, accessibility, and non-constant marginal costs [15,16] Nor is it clear whether increases in coverage are sustained over time. These include integration of ITN distribution with measles vaccination campaigns [17,18,19], implemented in 18 countries from 2003 to 2007 (Mark Grabowsky personal communication) and social marketing through public sector facilities in Malawi and Kenya [20,21]
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