1. Integrated ITN catch-up in campaigns Experience from Lindi and Mtwara regions, Tanzania Alex Mwita – NMCP Tanzania 3 rd WIN meeting, Basel 1 st - 3 rd March 2006

2. Background- Chronology In January, 2005 at the Davos Economic Summit, Sharon Stone initiated a fundraising campaign for ITNs for the children of Tanzania for and on behalf of retired President Mkapa 1million USD pledged In April NMCP and GFCCM Tanzania strongly urged by RBM Secretariat to use this money for free ITNs distribution despite the ongoing voucher scheme, already 7 months in operation

3. Background- Chronology..2 A consensus reached to buy LLNs and piggyback onto the measles, Vit. A, deworming campaign due in July, 2005 Lindi and Mtwara regions selected for free distribution due to their highest levels of child mortality Lindi: IMR 129/1000, <5 Mort. 217/1000 Mtwara: IMR 126/1000, <5 Mort. 212/1000 National average: IMR: 99/1000, <5 112/1000 The two regions informed, upbeat, starts advocacy campaigns NMCP teams up with EPI programme and other partners to work on the logistics

5. Background- Chronology..3 NMCP places an order for LLN with A-Z factory promising, money soon coming from Geneva By June, promised 1m USD nowhere to be seen, UNICEF steps in to rescue the situation A-Z cancels LLN orders, says there enough bundled nets, if we wish

6. Background- Chronology..4 Decision reached to go for bundled nets and to limit distribution to Lindi region Mtwara slated for December 2005 campaign 147K Usd of Sharon’s funds finally arrives in September 2005

7. Number of nets distributed Lindi-165,000 bundled nets Mtwara- 215,250 bundled nets Red Cross distributed--- nets to some wards in Rufiji and Pangani districts

8. Evaluation of Lindi campaign Results: 574 households with 354 children less than five years old were interviewed. Of eligible children, 79.6% received a bed net, 82.5% received measles vaccine, 80.6% received mebendazole and 85.0% received vitamin A.

9. Evaluation-November 2005 As a consequence of the campaign, household ownership of any bed net increased from 53.0% to 69.3% with an equity ratio of 0.97. Household ownership of an insecticide treated bed net (ITN) increased from 13.3% to 24.7%.

10. Evaluation-November 2005 Caretakers reported that 46.3% of all children less than 5 years old slept under a bed net and 21.5% of children less than 5 years old slept under an ITN the previous night.

11. Evaluation-November 2005 35.9% of children less than five years old were reported to have slept under a campaign net the previous night, and 17.7% of children less than five years old were reported to have slept under a campaign ITN the previous night.

12. Bednet and ITN Use Use of ITNs was lower than ownership. The most common reasons for not using a net were lack of mosquitoes 63.1% and the net not hanging 31.9%

13. Evaluation-November 2005 Discussion: Integration of malaria prevention activities with immunization campaigns is an important strategy to rapidly increase coverage and use of bed nets and merits continued large-scale implementation and evaluation.

14. Implications of free ITNs distribution for Tanzania The policy – cost sharing. Waivers for the vulnerable, senior poor citizens >60yrs and the poorest Free distribution improves net coverage in a short period Free distribution discourages commercial sector distribution The Voucher scheme has shown 85% redemption rate Working out a mechanism for an equity voucher

15. I thank you for your attention