Process evaluation of mosquito net distribution programme in Nigeria

The Issue

In Nigeria, 97% of the population is at risk of infection with malaria. Substantial progress has been made in malaria control, including through the distribution of insecticidal nets, and the National Malaria Strategic Plan calls for 80% of targeted populations to utilize malaria prevention measures by 2020. The Global Fund, in collaboration with the National Malaria Elimination Programme, conducted a net distribution programme across several states in 2017-2018.

Tropical Health, in partnership with the Johns Hopkins University Center for Communication Programs (JHUCC), was commissioned to evaluate the programme’s efficiency and effectiveness and make recommendations to inform decisions on future funding.

Our Approach

Tropical Health used a mix of qualitative and quantitative methods, collecting data at national, state, local government area and health facility levels, conducting key informant interviews, holding focus group discussions with beneficiaries and directly observing continuous distribution in health facilities and campaign processes. A rapid survey using lot quality assurance sampling was undertaken as post campaign monitoring. This was supplemented by advanced secondary analysis of supply, distribution, and financial data.

Tropical Health delivered a comprehensive report evaluating four areas; campaign-based net distribution, continuous distribution, supply chain management and cost per net, answering four key questions about efficiency and effectiveness, and providing 18 recommendations to inform future funding and operational decisions.

Our Findings

Tropical Health’s evaluation showed that significant efforts are being made to ensure efficiency and effectiveness in campaign-based distribution of nets but access to nets through campaigns is not maximized due to shortfalls in the allocation of nets and distribution practices. Continuous distribution is a larger challenge due to gaps in training programmes, supply of nets and data collection. Calculations of distribution cost per net resulted in a wide range among states. Tropical Health made targeted recommendations for improvement, each marked with high or medium priority and assigned to responsible stakeholders. The report was used to inform re-funding of the programme by The Global Fund in October 2018.