Integrated Universal LLINs Distribution and Maternal & Child Health Campaign in Sierra Leone. November/December 2010 By Nelson Fofana Delips Alieu

Country Profile  Sierra Leone is located on the West Coast of Africa, between latitude 8 30 o north and longitude 11 – 30 o west.  It is bounded by Guinea on the North and East, and Liberia on the South.  The Atlantic Ocean forms a beautiful coastline to the south and west of the country.  The country has a typical tropical climate with temperature ranging from 21 o C to 32 o C with a mean daily temperature of 25 o C.

Country Profile  It has two major seasons; wet season (May to October) and dry season (November to April) with heavy rains in July/August.  It has an average rainfall of about 320cm annually.  Relative Humidity is high ranging from 60 to 90%.  The country has a varied terrain, ranging from coastline swamps, through inland swamps and rain forest to one of the highest mountains in West Africa, Bintumani at 2200m

Country Profile  The vegetation is mainly secondary palm- bush, interspersed with numerous swamps that are mostly cultivated for rice.  These swamps provide ideal breeding places for the Anopheline vectors of malaria.  Moreover, the coastal line has several mangrove swamps, which provide the breeding sites for Anopheles melas mosquitoes, which is one of the major vectors of malaria besides gambiae and funestus.

INTRODUCTION  The Government of Sierra Leone is striving to reach both the:  Roll Back Malaria 2010 targets (in this case, 100% coverage of all population at risk with LLINs) and  the Millennium Development Goals (MDGs) by  In order to achieve MDG 4 (reduce by two-thirds, between 1990 and 2015, the under five mortality rate),  Sierra Leone needs to rapidly scale up and/or sustain coverage with key interventions:  including LLINs, vitamin A supplements and treatment for intestinal worms.  These interventions complement recent efforts to both improve routine vaccination services and ensure high coverage with measles and polio vaccines through regular supplementary immunization activities.

Overview of the process followed to develop the plan  The Ministry of Health and Sanitation, in collaboration with development partners, will organize the second Maternal and Child Health Week (MCHW) of 2010 from November 26th though December 2nd.  The MCHW will be combined with a universal coverage distribution of LLITNs.  A total of 3,264,927 LLITNs will be distributed in the country during the campaign. The campaign will run for seven days.

MCHW and LLIN campaign implementation processes  Micro planning with partners including representatives of line ministries  Training of trainers at central level, followed by training of district and zonal supervisors and then training of community health workers and then team supervisors;  House-to-house administration of Vitamin A for children 6 – 59 months and Albendazole for children 12 – 59 months;  Household registration during the MCHW (a third person will be added to each team) and distribution of vouchers for LLITNs;  Redemption of vouchers for LLITNs at fixed distribution points that are open from day 1 of the house-to-house activities.

Goal of the plan  The overall goal of the Maternal and Child Health campaign is to reduce morbidity and mortality in children less than 5 years of age particularly by achieving high coverage of Vitamin A supplementation, Albendazole for treatment of intestinal worms, and universal distribution of LLINs.  There are specific targets for Vitamin A and Albendazole  The entire population is targeted for the distribution of LLINs.  The National Malaria Control Programme has set a national target of one net for two people.  One voucher will be for one LLIN. This distribution strategy is geared towards reaching universal coverage of all populations at risk, based on an average household size of six people.

Elements of the plan  The communication strategy has been designed using the Health Belief model and uses a mix of approaches, including radio, key influencers within the community, interpersonal communication channels to inform, encourage, and reinforce messages to facilitate adoption and maintenance of positive behaviours on ITN ownership and utilisation.  Mobilising community members for health promotion and who are residents of the community is the best and most-sustainable way of promoting ITN use within the community.

HOW THE PLAN WILL BE USED Advocacy Advocate with H.E. The President for his participation at the national launch on November 25 in Makeni. Advocate with Ministry of Local Government and Community Development for involvement and support of local councils and traditional authorities. District and chiefdom level advocacy meetings for involvement, ownership and support for Nov campaign. Social Mobilisation Radio and TV Health Fairs on November 25 at chiefdom level Interpersonal communication District level meetings with Paramount Chiefs and Local Councillors Meetings and orientations with key groups to mobilise communities and establish positive behaviour reinforcement channels. Theatre for Development (TFD) IEC materials

Management of logistics operations At central level, a logistics sub-committee, with members from various partner organizations, has been established. The logistics sub-committee includes personnel from the MoHS, UNICEF, WHO, SLRCS and other Civil society partners. The logistics sub-committee reports to the National Task Force. At district level, the DHMT will be responsible for the planning and implementation of the logistics operation, supported by the logistics sub-committee, beginning with developing a micro plan and budget for the movement of all supplies from the district storage locations to the chiefdoms / distribution points. At chiefdom level, PHU staff, councilors and community leaders will be responsible for storage and security of the LLINs at the distribution point level.

Successes and lessons learned  Plan in Place and accepted by all stakeholders  Some people associate discomfort with sleeping under ITNs.  There is a low perceived risk from mosquitoes despite Sierra Leone being a malaria-endemic country.  This can be attributed to low awareness about the causes of malaria (wrong attribution – mangoes, witchcraft, seasonal influenza), preventive measures (ITNs), effects and symptoms which also leads to wrong self-diagnosis and delayed care seeking.  Therefore, routine and campaign messages and communication need to focus on increasing awareness about the causes of malaria (knowledge), sleeping under ITNs is comfortable (emotional trigger), and is the most cost effective malaria prevention method.

Successes and lessons learned  Communication messages and activities should convey and reinforce that the health benefit derived from sleeping under ITNs is greater than the benefit from non-use or sale in the market.  Delayed responses from partners  Irregular attendances at meetings makes it difficult to reach a consensus on the messages

Budget  Districts will be requested to provide an estimated budget to carry out their transport operation. Budgeted costs will include:  Cost for renting trucks or other means of transportation (if applicable);  Cost of fuel (indicating number of liters) if using own vehicles;  Cost of renting warehouse space (indicating from whom);  Cost to be paid to personnel / workers (indicating number of people, functions and rates  Budget was developed for IEC Materials, jingles, Radio discussion, posters, flyers, drama groups,  Others areas include; operational cost, training, planning and coordination, M&E, Albendazole, LLIN &VIT A