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How do you accountably register millions of people for malaria nets? Ask AMF.

Schoolchildren in Ghana receive antimalarial nets.

By Rob Mather, Against Malaria Foundation CEO

With World Malaria Day coming up on April 25th, AMF is pleased to report that we continue to make progress with significant distributions recently completed in Malawi (4.3 million long-lasting insecticidal nets now protecting 7.8 million people), Ghana (3.6m LLINs, 6.5 million people), distributions about to get underway in Guinea (4.8m LLINs, 8.7m people) and in the Democratic Republic of Congo (3.4m LLINs, 6.1m people – two linked distributions), and a further shipment of 8.4m nets to protect 15.1m people in DRC expected to be underway in the next few months. 

The work of providing long-lasting anti-malarial bednets to the world’s vulnerable populations is not a simple matter of delivering bales of nets to a village and walking away. AMF is a recommended charity of GiveWell and The Life You Can Save because we are meticulous about carrying out a rigorous series of steps before, during and after every distribution, including detailed documentation and data-driven reporting for transparency and accountability.

One of those steps is registering all the households in the region where we will distribute nets. The registration phase is not just a matter of having people sign up for nets; it is a multi-step, detailed process to ensure that each household is visited to assess need so that each receives the nets to protect all sleeping spaces and as a result the distribution is highly accountable. As you can imagine, this is a huge job, since we are coordinating, with partners, distributions that cover millions of households, but it is essential for running an effective net programme. And when done with rigorous oversight, the process is even more involved than you might guess. Our current registration in Guinea is a good example of the undertaking.

Registering millions of net recipients in Guinea

Guinea has a significant malaria problem and the majority of the population requires nets to avoid the nighttime bites of malaria-carrying mosquitos that would otherwise cause severe illness, or worse. The registration of 1.35 million households has just finished. The households, covering a population of 8.9 million people, will receive nets in the nationwide universal coverage campaign that will take place in April and May 2019. The four regions that will receive 4.8 million AMF-funded nets are Boké, Faranah, N'zérékoré and Kankan. In these regions, the 1.35 million households were registered in 12 days by 6,900 community health volunteers with management and supervision at sub-district, district and regional level by Guinea's National Malaria Control Programme (NMCP).

A number of data-driven mechanisms were in place to maximize and provide evidence for the accuracy of the registration.

  1. "105% Registration"
    Community health workers, coordinated by the NMCP, carried out "105% registration" whereby 100% of the households were visited to establish net need for each individual household, and then a random sample of 5% of the households were re-visited by a separate group of data collectors with no knowledge of the 100% data collected. Importantly, those carrying out the 100% registration were aware re-visits would take place. This acts as a mechanism to encourage accurate registration.

  2. Independent monitoring
    AMF funded an independent organisation to monitor the way the registration was managed and carried out by the NMCP. The 100% and 5% registrations were monitored closely in 40 randomly selected villages. This monitoring provided quantitative and qualitative insight into the registration process and was carried out in the spirit of wishing to know how well things were going, what challenges were faced by the teams carrying out the work and what lessons could be learned for this and future campaigns.

  3. Independent Village Re-registration (IVR)
    An independent organisation, funded by AMF, carried out the whole village re-registration of 40 villages, selected at random, with the very specific objective of recording the details of all households in each of the villages. The data collected was compared with the 100% registration data. This provided AMF with an independent source of information to help assess the accuracy of the NMCP-led registration.

  4. Electronification of household records
    Household registration data collected on paper were sent to a data entry centre located in the capital, Conakry, where they were entered into AMF's Data Entry System (DES). AMF funded this work, carried out by 500 data entry clerks. This transparent process allows visibility for all partners of household records, and analysis of them. This would not be possible if paper-based records remained at individual health facilities and only summary numbers were sent to the NMCP.

3.5 million nets funded by AMF have now arrived in Guinea and a further 1.3 million nets will shortly be on their way to make up the total of 4.8 million. The 1.3 million number was settled on having analysed the registration data - actual numbers therefore, not estimates based on uncertain data, and these nets will ensure complete protection of the population in the four regions. This 'split-shipment' approach, with the second quantity shipped guided by actual registration data, allows us to be accurate and not wasteful with the number of nets we fund and distribute whilst ensuring all those that need to be protected receive nets.

You can help close our funding gap

We are currently trying to close a significant funding gap of $45m. The slide below shows how important the many donations we receive are. The bedrock of our support is the many individual donations we receive: every $2 matters, as every $2 net protects two more people.

You can read more about AMF here and support their work here

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