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Operational challenges to continuous LLIN distribution: a qualitative rapid assessment in four countries
Katherine Theiss-Nyland1, Waqo Ejersa2, Corine Karema3
1Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. katherinetn@gmail.com.
Malaria Journal
|March 3, 2016
Summary
Continuous distribution of long-lasting insecticidal nets (LLINs) faces stock-out challenges in sub-Saharan Africa. Improving supply chain management and data systems can enhance LLIN access for malaria prevention.
Area of Science:
- Global Health
- Public Health Interventions
- Malaria Control
Background:
- The World Health Organization (WHO) recommends continuous distribution (CD) of long-lasting insecticidal nets (LLINs) via antenatal care (ANC) and the expanded programme on immunization (EPI) for malaria prevention.
- Despite WHO recommendations, many countries lack LLIN CD policies, and implementation remains incomplete where policies exist.
Purpose of the Study:
- To identify operational strengths and weaknesses of LLIN CD programs in four sub-Saharan African countries.
- To understand the challenges hindering effective LLIN distribution through routine health services.
Main Methods:
- A qualitative rapid assessment process was employed, involving semi-structured interviews with 70 participants across national, sub-national, and facility levels in Kenya, Malawi, Mali, and Rwanda.
- Data were triangulated through policy document review and analysis of data collection tools, focusing on health systems themes.
Main Results:
- Varied management systems for LLIN supply led to stock-outs at the facility level, exacerbated by issues in quantification, logistics, and data collection.
- None of the studied countries had guidelines for stock-out response or systems for local staff to request resupplies.
- Incomplete or absent facility-level data on LLIN distribution hindered planning, and staff training was less frequent than desired.
Conclusions:
- Stock-outs represent the primary operational obstacle to effective LLIN CD in the studied countries.
- Empowering facilities to order LLIN resupplies as needed can prevent stock-outs.
- Revising data collection and management systems for LLIN distribution is crucial for improving stock-out response, monitoring, and evaluation, ultimately increasing population coverage.
