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Pre Distribution Monitoring-LLIN Campaign

AMF-PACE UGANDA Pre-Distribution Monitoring Activities of the LLIN Campaign

Background

PACE with funding from Against Malaria Foundation (AMF) implemented the Pre-Distribution Monitoring (Pre-DMs) of the 2020 LLIN mass campaign. Uganda conducted its third Universal Coverage Campaign (UCC) for the LLINs distribution in 2020 with an aim of increasing access and ownership of nets in communities across the country. Use of long-lasting insecticidal nets (LLINs) is recommended as the primary strategy for prevention of malaria in Uganda (MoH , 2020). In Uganda, malaria is the leading cause of mortality and morbidity and accounts for over 30% of outpatient visits and 20% of hospital admissions. To counter these deaths, the Government of Uganda (GoU) has deliberately intensified Malaria prevention interventions including distribution of LLINs that have resulted in a significant reduction of malaria prevalence from 19% in 2014 to 9.2% (MoH, 2019).

The third UCC for LLINs was unique compared to the previous campaigns where the Ministry of Health through the National Malaria Control Division implemented it through its structures without a Non-Government lead entity. The logistics were handled by the National Medical Stores that managed both the warehousing of LLINs and the last mile delivery of LLINs to the sub county stores. The nets during the campaign were provided by Against Malaria Foundation and the Global Fund.

PACE as An Independent Monitor

To enhance an effective UCC campaign, it was imperative to conduct Pre-Distribution Monitoring activities.  The Pre-Distribution Monitoring incorporated elements of the entire campaign (from planning to distribution of the LLINs). This was to give assurance that NMCD and its implementing partners carry out the registration and distribution of LLINs according to the procedures as stated in the Universal Coverage Campaign (UCC) implementing guidelines, procedures agreed between NMCD and AMF. The guidelines comprehensively provided step by step processes and procedures as spelt out in the data management plans, logistics Plan of Action, Social Behavioural Change and communication manuals. PACE Uganda, a Non-Government indigenous Organisation was selected as the independent monitor for the Pre-Distribution Monitoring activities. PACE’s role was to ensure that the set above guidelines are adhered to by NMCD and its partners at all levels of the campaign. Working with national and district level structures and utilizing electronic monitoring systems, PACE implemented the Pre-Distribution Monitoring (Pre-DMs) activities from the national level to village/household levels in 25 districts across all the regions in Uganda in 5 waves between May 2020-March 2021.

A map of monitored districts per wave

Objectives of the Pre-distribution Monitoring Activities

  1. To ensure accountability and adherence to the AMF-MoH agreement and other guidelines with reference to UCC planning, training, registration, distribution as well as the delivery mechanism and capabilities.
  2. To determine whether AMF nets are distributed to the intended beneficiaries in the quantities listed and that all nets not distributed are held securely and accounted for.
  3. To address any concerns arising during planning, training, registration, and distribution activities thus ensuring effective management of the UCC during the implementation period relatedly documenting lessons learnt to further enhance implementation in the subsequent campaign waves.

Findings from the Monitoring Visits.

Amidst Covid19 pandemic, the government of Uganda through Ministry of Health successfully conducted its third Universal Coverage Campaign for the distribution of free mosquito treated nets with a theme of ‘Under the Net’. A total of 27.5 Nets were distributed to the people in Uganda between August 2020 and March 2021.  It was the first digitalized LLIN mass campaign to be implemented in the country.

As recommended, Key issues that were flagged to NMCD by the PACE data monitoring teams were immediately resolved. Below is a summary of the key findings.

  • Due to NMCD’s advocacy, social mobilization, and Behaviour Change Communications strategy awareness about the nets distribution at household level increased to 99%. All households reported having received information on when the nets will be distributed.
  • 99% of the households monitored reported to have been given information on net use and net care
  • Due to the efficiency of the EDMIS, the time spent at each household was in line with NMCD guidelines in 99.6% of the households.
  • In all the monitored households the data collector was accompanied by a volunteer who was either a VHT or a chairperson LC1 or both.
  • Data were collected using an electronic device in 73% of the monitored households across all districts and electronic devices were working properly in 93% of the households.
  • Among the data collectors, 83% were able to charge their phone batteries and never experienced challenges during the household registration and distribution exercise.
  • 84% of households received nets that matched the number allocated by the EDMIS.

 

  • At distribution, 87% of the households were verified using the EDMIS where the distribution teams were calling the names of beneficiaries before issuing out the nets. Nets were distributed to only identified members in 100% of the monitored sites.
  • 100% of nets were distributed free of charge without any exchange money in monitored sites.
  • As recommended, 100% of parish chiefs did not have access to the data collected during the household registration and distribution teams.
  • As per the guidelines, in all the monitored sites, 100% of the parish chiefs were not part of the team that collected data for 100% of household registration and distribution in the monitored villages.
  • The 105% revisit was done independently and according to the plan by the parish chiefs as guided by NMCD supervisors.
  • Parish chiefs randomly visited the households provided by the sub-county supervisors in some sites following the agreed process.
  • 100% of the parish chiefs were fully aware of their participation in the 5% revisit and data was collected for all households sampled for 5% revisit in the monitored sites.
  • Overall UCC 2020/2021 LLINs campaign adherence to Standard Operation Procedures (SOPs) is as show below;