Evaluation of DRC routine insecticide-treated net distribution

The Issue

The DRC National Malaria Control Programme (NCMP) uses mass campaigns and routine distribution of insecticide-treated nets (ITNs) to pregnant women at antenatal clinics and infants at vaccination visits as the primary components of its vector control strategy. In 2014, the programme wished to review whether the combination of campaigns and routine distribution was achieving universal coverage targets, whether routine distribution was effectively reaching target groups, and whether any additional or alternative channels would help achieve universal coverage.
Through PMI NetWorks, a five-year $60 million global project aiming to scale up vector control for malaria prevention through improved distribution of ITNs, Tropical Health participated in an assessment of the ITN distribution systems in DRC, providing logistics expertise and a local health systems consultant.

Our Approach

Due to time and funding constraints, two sentinel provinces were identified in consultation with the NMCP. Key informant interviews were conducted with national, provincial, district, health zone, and community-level actors responsible for ITN distribution. Quantitative data on ITN distribution were reviewed and the NetCALC model was used to project coverage under the current and potential distribution systems. Tropical Health provided consultants with extensive logistics and supply chain management expertise to provide recommendations on improving logistics planning.

Our Findings

The assessment found that the strategy of combined campaigns with routine antenatal care (ANC) and expanded programme on immunisation (EPI) distribution could achieve and maintain universal coverage, but would be less cost-effective than a fully continuous approach. There was significant variation in the ability of the routine channels to reach target groups. The report recommended adjustments to the supply chain for routine ITNs. The report also recommended that DRC consider school-based distribution to bolster ITN coverage, particularly in scenarios where ITNs had a median lifespan of under three years, and made recommendations for reinforcing monitoring and evaluation systems and social and behaviour change communication.