Transcript Integrated Maternal & Child Health week & LLINs Universal

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 30o north and
longitude 11 – 30o 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 21oC to 32oC with a
mean daily temperature of 25oC.
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 palmbush, 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 2015.
 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