Context
Uganda has a population of 43.7 million. The country has 146 districts, 1,488 subcounties, and 58,197 villages. The country experiences stable, perennial transmission is over 90% of the country with transmission peaks related to the two annual rainy seasons.
The outbreak of covid-19 pandemic was first reported in Uganda on March 21, 2020, when a case arrived through the country’s international airport country underwent lock down and this disrupted the commencement of ITN campaign that was slated to begin in March 2020. However, it began in April 2020 and ended in May 2021. The objective of the campaign was to ensure that at least 85% of the targeted population has access to LLINs.
Campaign Implementation Design
The campaign was designed to be district led with decentralized structures taking a lead role in planning and distributing nets to the household level. The National Coordination Committee (NCC) chaired by the Permanent Secretary of the Ministry of Health played the overall oversight of the campaign. It was supported by four technical subcommittees namely logistics, Social and Behavior Change Communication (SBCC), operations, and Monitoring and Evaluation (M & E). These were led by technical people in the National Malaria Control Division of the Ministry of Health and membership was obtained from the NCC.
Campaign Implementation Process
Macroplanning: The ITN need was quantified based on the projected figures from UBOS. Types of ITNs to be deployed in various locations were decided based on the insecticide resistance patterns. Three (3) types of nets were ordered for namely Standard (Non-PBO, PBO) and dual-active. Over 95% of the ITNs procured were Polyester due to limited acceptance of hard nets in the previous campaign of 2017/2018.
Microplanning: A team of technical people were trained and provided with a microplanning developed consultatively with malaria partners and the Alliance for Malaria Prevention (AMP). Using this tool, data was collected from districts and teams went up to subcounty level. The data was validated and produced in district microplans stipulating the net and non-net deliveries to be made to each sub-county. The microplan also had a district budget broken down to sub-county budgets based on the administrative units in each. We considered villages, parishes, and sub counties.
Procurement and Delivery of LLINs: The ITNs were obtained with funding from GF and AMF. Quantities of nets required for each wave were quantified. Orders were made one year earlier to allow for manufacture and shipment of orders. Delivery was also staggered due to warehouse storage constraints. A total of 28,805,800 nets were procured. They were warehouse at the National Medical Stores (NMS). The NMS was also responsible for delivery of nets up to subcounty stores. We utilized the already existing systems of distribution for pharmaceutical and health supplies. Microplanning data collected from districts was used in deciding on the quantities allocated per sub-county in each district. Logistics tools namely stock cards, waybills and tally sheets were used for tracking and accountability for LLINs and other non-LLIN commodities across the supply chain. Delivery of nets to each village was based on registration data from households per day. These nets were collected from prepositioning centers located at parish level. Excess nets underwent redistribution or reverse logistics where applicable.
Training: Training manuals were utilized to provide guidance in training. We began with a training of trainers that involved secretariat staff and district supervisors. Training was then cascaded down to subcounty supervisors who in turn trained people in the district. Training for data collectors was practical since they had to learn how to use phones and install apps that they were to be familiar with.
Household Registration: Registration was done by data collectors who went to each household and entered data from an adult household head. Registration determined how many nets were to be delivered to the households by the Village Health Teams (VHTs) and Local guards. A cap was placed on how many nets could be received by each household.
Mass Distribution: Distribution at household level by done from house to house after registration except for areas that were sparsely populated. Household members were taught how to use the net and where to hang them
Supervision: Supervision was done by sub-county supervisors who worked along with Parish Chiefs
Data Management: We utilized an electronic data management system to monitor and implement all campaign activities. A user-friendly app was developed and piloted to collect data offline using all types of smartphones. Collected data was transmitted after accessing internet. Data analysis was carried out by M & E officers assigned to various districts in each wave. 105% data verification was done by parish chiefs.
Social and Behavior Change Communication (SBCC): Key approaches for SBCC were advocacy, mass media, interpersonal communication, Information, education, and communication (IEC), and social and community mobilization. The branding of the campaign was dubbed “Under the Net” which resonated with the campaign objective. National-level advocacy was done to introduce the campaign to national-level stakeholders. This was followed by regional and district-level advocacy meetings. We utilized mass media, social media, and IEC materials to send out campaign communications. Community mobilization to increase their participation was done through megaphones and mobile trucks. The call center at MoH was instrumental in collecting feedback from communities after completion of LLIN distribution.