Continuous Distribution Strategies to Sustain Universal Coverage with LLIN Nasarawa Community Distribution Preliminary Results This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the presenter and do not necessarily reflect the views of USAID or the United States Government.

Objectives of Evaluation To assess the level of net and LLIN ownership in households comparing different channels of distribution To assess the use of nets in general and LLIN in particular by different population groups Primary

Objectives of Evaluation Measure the equity in access to nets from various sources Obtain detailed information about net use and sleeping patterns in the family Evaluate the success of the IEC and BCC activities associated with the program Secondary

Community-based Distributions Depends on families taking initiative to request new LLIN Community-agent s trained for NTD MDA serve as a link to verify need and issue coupon Hubs to give out nets are health facilities 4

Evaluation Surveys Population representative household surveys with cluster-sampling design Sample size 1020 households (60 clusters, 17 hh) Before-after comparison between baseline and endline surveys 5

Results Household characteristics

Demographics IndicatorBaselineEndline Households in sample Mean # of persons/household5.0 % of population U513.3%15.6% Households with any U547.1%55.4% Households headed by females24.8%18.5% Households polygamous49.8%32.0% Mean age of head of household

Household Assets IndicatorBaselineEndline Has radio79.2%72.8% Has TV41.0%40.8% Has mobile phone61.0%65.8% Has any transport70.4%73.9% Has fridge10.3%13.5% Owns land79.0%75.1%

Results Access to new nets

Nets obtained after campaign All householdsIf got any new nets Facility + CDD 18.5%Facility + CDD 68.5%

Who got new nets Access to new nets did not differ by rural/urban, family size or wealth quintile But was much higher among households who also reported having received an campaign net

Who got nets from where If household got any new nets CD ChannelsCommercial or Family

Results CDD implementation

Awareness of CDD Program Only 32.2% of households in Nasarawa knew about CDD program This did not differ between wards with or without distribution point But was higher in urban communities

CDD Program Effectiveness All sampled households

Program Effectiveness Households aware of CDD program 92% CDD ran out of coupons 46% no nets in stock 49% too far to walk

Program Effectiveness Reasons for not requesting nets from CDD if aware of CDD program Reason for new nets if requested: 81% never got nets 10% don’t have enough 9% replacing old nets

Results ITN ownership

Net output IndicatorValue LLIN delivered to State for CD245,850 Estimated LLIN distributed through facilities49,419 Estimated LLIN distributed through CDD32,005 Estimated LLIN distributed through ANC20,709 Total distributed through CD102,132 Distributed as % of delivered41.5% Distributed as % of annual need for UC27%

Trend in ITN Ownership Campaign CDD ANC

Trend in UC indicators

Impact of CDD Distribution Comparing households aware of CDD program with others

Intra-Household Supply with ITN

Results Equity

Equity of ownership Any ITN Endline: source of new net

Equity of ownership Any CD Any CDD

Results Knowledge, Attitudes, Perceptions

Exposure to Messages on Nets Any message heard Source if any message heard

Recall of Messages If any message heard

Impact of BCC Discussed net use in familyIntent to use every/most nights Exposure to messages leads to discussion of net use in family which leads to intention to use frequently

Impact of BCC Among households aware of the CDD program those very confident to take action regarding nets were much more likely to get nets from the CDD/HF pull system

Results ITN use

Surveys in Relation to Rains

The Use Gap Access vs. use

Use at Population Level Only Households with 1 ITN / 2 people

Who used which ITN Only Endline Survey

Conclusions In principle, the continuous distribution achieved a significant impact on ITN ownership whithout oversupplying Distribution channels were largely complementary with very little overlap However, implementation was done very late and at an insufficient level of efficiency (low awareness, stock-outs of coupons and nets) This resulted in not sustaining campaign results and continued drop in UC

Conclusions (2) In a pull system like the CDD program, a strong household confidence to take action to get nets is critical and BCC must be structured accordingly Special attempts must be made to reach and involve the poorest wealth quintile Although ITN use was generally lower in the dry season, under 5 use was high even then