Step 4: Quantify Your Net Need

Objectives

  • Develop a macro-quantification plan to describe predicted commodity needs for each channel on an annual basis.
  • Develop a micro-quantification plan estimating ITN need, by channel, at lower sub-national levels (by village, at lowest level).
  • Validate the micro-quantification plan(s) with district and regional officials

Outputs

  • ITN macro-quantification plan
  • ITN micro-quantification plan (for all CD channels)

  • Schedule a coordination committee meeting to conduct macro planning using NetCALC (could combine with meeting in Step 2).
  • Conduct a micro-planning exercise, as appropriate, to the context and channels. This may involve holding several sub-national micro-quantification meetings with the outputs combined nationally into a national micro-quantification plan.

  • First, develop a macro-quantification plan that determines how many ITNs will be needed to maintain coverage and approximately how many will be delivered through the different CD channels.
  • Use NetCALC to do this; use the guidance tools to help.
  • When using NetCALC, be sure to note that NetCALC predictions of impact on ownership levels assume a high degree of inter-household redistribution. For ease of design, the NetCALC model is based on the assumption that ITNs are distributed evenly across households in order to estimate population coverage. We do not have evidence to support or disprove this assumption. Given this, planners should not rely solely on NetCALC predictions, but should consider what proportion of the population live in households likely to be reached by the proposed channels, and ensure distribution channels complement each other and reach as much of the population as possible. A tool is available to assist in these calculations.

  • A micro-quantification plan describes how many ITNs are needed in each distribution site (e.g. village, health facility, school) per year. More extensive inputs from regional and district personnel closely involved with the channels in question, and with working knowledge of the relevant sub-national level, will be important here to generate pragmatic and realistic estimates of need. A national micro-quantification is normally a compilation of all the relevant district micro-quantifications.
  • Both macro- and micro-quantification plans should include a buffer supply of ITNs to allow for unexpected uptake.

  • Health facility distribution quantification should be done with the gap analysis tool developed by the Harmonization Working Group.
  • ANC nets are quantified by estimating population * % of pregnant women in malarious areas (generally 4% of the population), and can be adjusted if ANC coverage is not universal, and/or informed by consumption data from previous years of ANC ITN distribution.
  • The same process is used to quantify EPI.

  • By each district and each health facility, ANC and EPI needs should be estimated and verified with the regional and district officials. Data on ANC and EPI service delivery over the past 2-3 years (from HMIS) should be used for these estimates.
  • If there is pent-up demand expected at the beginning of health facility distribution, either because the channel is new, or if it has been several years since the last mass campaign, expect the initial 3-6 months of ITNs to be consumed in about half the regular time, and plan for resupply accordingly.
  • The VectorWorks document, Guide to Health Facility-based Distribution of Insecticide-treated Nets provides more detail on these issues.

  • NetCALC can be used for macro-quantification for community distribution. Based on the desired target level of ITN access, the average number of ITNs to be distributed to each household per year can be selected.
  • As an example, if community and health facility channels are being used to replace mass campaigns, each household should on average receive about 0.5 to 0.75 ITNs per year through the community channel. If community channels are being implemented in conjunction with mass campaigns or other large-scale distributions (e.g. through schools), this will be less.
  • There is generally no historical data on consumption of ITNs through a community channel. Therefore, quantification will be initially based on rough estimates (e.g., the gap to universal coverage not covered by other channels; and then will be based more on actual consumption, supervision, and results from monitoring activities.
  • Community-based distribution can, in theory, consume an infinite quantity of ITNs. Limits are set by restricting quantities ordered and supplied at each level and through strong supervision and enforcement of eligibility criteria. Including stock thresholds that trigger resupply, and ensuring good training on these matters, will be critical because it is impossible to make accurate predictions.

  • Microplanning will require having the number of households and/or population for each catchment area. The overall planning figure (e.g. 0.5 ITNs per household per year) can be applied in each catchment area to generate quantities of ITNs required for the year, and divided by four to generate quarterly delivery quantities. These estimates must be confirmed at the lower levels during workshops with local implementers and community leaders, where the estimates are discussed and reviewed by the people who know the communities well, and can say whether ITN consumption patterns fit the original expectations; whether certain communities are difficult to access, etc.
  • Initial demand will probably be far higher than ongoing demand, depending on the success of the preceding campaign and the time since that distribution. This initial higher demand may last weeks or several months. A conservatively high number will ensure an initial adequate supply is available so that distribution can start smoothly.
  • The VectorWorks document, Guide to Community-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

Macroplanning for school distributions is crucial and has three steps:

  1. Using NetCALC, estimate the number of classes required to maintain ITN access at the targeted levels, and the total number of ITNs required. As with the other channels, this may vary depending on whether school distribution is the primary channel, or if it is being implemented in conjunction with mass campaigns or other channels. If the former, we generally observe that between 4-6 classes should receive nets each year, depending on enrolment and drop-out levels.
  2. Using available enrolment figures, confirm that distributing ITNs to the targeted classes in Step 1 achieves the total number of ITNs required. If not, additional classes may need to be added.
  3. The macro-quantification may be different in different regions of the country, necessitating different numbers of classes to achieve the desired ITN access. Separate macro-quantifications may be necessary for each region to generate the national macro-quantification totals.
  4. When using NetCALC to inform macro-quantifications, note the following:
    • A country may vary considerably in gross enrollment rates from area to area. Dropout rates may be significant and the timing of the distribution (near start or end of year) should consider this. Use NetCALC to consider each area with different enrollment rates, which should give more accurate estimates.
    • Gross attendance ratios—needed for the NetCALC estimations for this channel—are often drawn from national surveys that measure enrollment, regardless of school type. Planners should check whether the attendance ratios they are using reflect the model design they are proposing. This disconnect between different steps in planning was seen in a number of countries. For example, if only public schools are included—but private school attendance is fairly high— then using NetCALC estimates to guide other decisions, such as which and how many classes to target, only makes sensible if the predictions are based on public school enrollment.
    • NetCALC includes an estimated value for planners to enter, predicting the “efficiency” of the distribution channel. This reflects how many of the ITNs moving through this channel will actually be delivered to the target beneficiaries. Experience to-date suggests planners should enter a value of approximately 85% to 95% for school-based distribution because annual distribution events targeting students in schools appear to be highly efficient. Both Ghana and Tanzania estimated that more than 90% of targeted students received ITNs

  • Micro-quantification for school-based distribution uses enrolment data from individual schools. These are compiled at district level and regional level to form the micro-quantifications.
  • As with other micro-quantifications, workshops are essential to confirm estimates, gather enrolment data, and assess transport routes for hard-to-reach areas.
  • The VectorWorks document, Guide to School-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

Lalji S, et al. 2016. School Distribution as Keep-Up Strategy to Maintain Universal Coverage of Long-Lasting Insecticidal Nets: Implementation and Results of a Program in Southern Tanzania Global Health Science and Practice. DOI: 10.9745/GHSP-D-16-00040.