Roll Back Malaria Partnership Working Group on Insecticide Treated Nets (WIN)

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Roll Back Malaria PartnershipWorking Group on
Insecticide Treated Nets(WIN)

• Update for the 7th RBM Board Meeting
• WHO Geneva
• March 31, 2005

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Outline of update
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Overview of WINProgress Products
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WINs Purpose Statement

• To provide the RBM Partnership with strategic
  advice to assist countries in
• their efforts to choose the most appropriate
  cost-effective malaria vector control
  intervention(s) and take them to national scale
  in pursuit of Abuja and Millennium Development
  Goals for malaria as well as child and maternal
  mortality reduction and poverty alleviation.

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WINs Core Membership (40)

• Endemic countries (8)
• Benin, Chad, Ghana, Mali, Mozambique, PNG,
  Tanzania, Viet Nam
• Multilaterals (7)
• GFATM, UNDP, UNICEF, WB, WHO, TDR
• Bilaterals (6)
• USAID, US CDC, French Cooperation, DfID, SDC
• NGOs (3)
• Futures Group, IFRC, PSI
• Private sector (4)
• A-Z Textile Mills Ltd., Bayer Environmental
  Science S.A., SiamDutch Ltd., Vestergaard
  Frandsen A/S
• Projects (3)
• Malaria Consortium, NetMark, Rockefeller Acumen
• Sub-regional networks (4)
• CARN, EARN, WARN, SAMC
• Other technical advisors (6)

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In the RBM Partnership Global Strategic Plan.
Personal Protection
Vector Control
ITNs
ITNs

• Prevention Vector Control
• Select proven technology
• Target most vulnerable (biological/SES)
• Reach high coverage quickly
• Sustain high coverage
• Ensure quality of products
• Develop and optimize technologies

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RBM WIN Terms of Reference

• WG Functions to assist ITNs (IRS) national
  scale-up
• Facilitating consensus on strategies
• Synthesizing knowledge and advocate best
  practices
• Facilitating capacity of RBM SRNs to respond
• Identifying emerging implementation research
  questions
• Contributing to ITN ME Indicators
• Promoting public private partnerships and
  targeted subsidies for provision of nets and
  insecticide.
• Where appropriate

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Workplan organization

• Five Satellite Groups
• Strategic and tactical frameworks
• Enabling environments best practices
• LLINs standards monitoring
• Quality control quality assurance (new in 2005)
• Implementation research (new in 2005), indicators
  methods for monitoring evaluation

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Products so far (1)

• Strategic and tactical frameworks
• 2nd Edition of RBM ITNs Strategic Framework
• Draft 18 March 05.
• Consensus achieved. Being finalized for
  publication
• RBM Policy briefs
• Consensus statement on ITNs IRS (Mar 04)
• Consensus statement on ITNs pregnancy (Mar 04)
• RBM Report on targeted subsidies guidance
  document
• Report published on RBM web (Sep 04)
• Guidance document in revision (expected Q2 05)
• WHO Technical Report Series on Vector Control
• (Significant RBM WIN input publication expected
  in 2005).

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Products so far (2)

• Enabling Environments Best Practices
• Inventory on taxes, tariffs regulatory
  environments
• NetMark workshop (Nov 04)
• UEMOA has data for francophone Africa
• Best practices advocacy tool on taxes tariffs
• NetMark
• Guidelines for common tendering and procurement
  practices
• Shifts to MMSS

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Products so far (3)

• LLINs Standards Monitoring
• Development of Strategic Business Plan
• Strategic (business) plan (Aug 04)
• Private sector meeting (Sept 04)
• Recommendations to Board and MMSS (Oct 04)
• Facilitate procurement forecasting roundtables
• Moves to MMSS
• Evaluate results of acceptability studies
• Olyset Multi-country study completed
• Analysis of reports in Q2 05
• Launch of Olyset Africa Production (A-Z) (Nov 04)

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Products so far (4)

• Indicators methods for ME
• ITN ME needs assessment
• pending
• Guidance for SRNs to inventory ME resources
• Pending
• Consensus on draft ITN indicators
• Framework of indicators in development
• Develop standardized costing framework
• Scheduled for Nov 05

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Proposed products for 2005-6

• Strategic tactical frameworks
• Dissemination of 2nd Edition of ITN Strategic
  Framework
• Develop/distribute reader-friendly version of
  latest Cochrane Review of ITN effectiveness
• 1st Cochrane Review of IRS effectiveness
• Update targeted subsidy models document
• Develop advocacy support package
• Improve synergies with other WGs.

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Proposed products for 2005-6

• Enabling environments best practices
• Technical assistance on taxes tariffs
• Update on TT for RBM website
• Streamlined tendering processes
• Increased ITN/LLIN production capacity
• Documented procurement practices

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Proposed products for 2005-6

• LLINs
• Assemble and disseminate data on LLIN lifespan
  washing habits
• Mobilize resources for LLIN testing
• Harmonize registration process based on WHOPES
• Upgrade LLIN strategic plan to investment plan

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Proposed products for 2005-6

• Quality control quality assurance
• Develop QC/QA testing protocol for use during
  production
• QC/QA workshop for net manufacturers
• Implementation research, monitoring evaluation
• Consensus on measures for costing, coverage,
  sustainability
• Guidance document on key ITN-related ME issues
  and methods for country programs via SRNs
• Draft implementation research priorities checked
  by SRNs and advocated to the Partnership

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Current Situation for ITNs
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ITNs in Africa (MERG)
These figures largely represent 1999-2000 Abuja
baselines
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Recent trends are promising
Source PSI distribution data
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UNICEFs ITN procurement 2000 2005
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Relatively recent coverage data

• Some countries already succeeded
• Togo gt95
• Eritrea gt60
• Some others are poised to reach the target
• Eg. Tanzania in 2003 distributed 2.3 million nets
  bundled with treatment kits and a further 2.5
  million insecticide retreatment kits. Currently
  7.8 million nets are in use in 7 million
  households, 70 of them treated. With the recent
  launch of virtually free nets via vouchers for
  the most vulnerable population, TZ is likely to
  meet Abuja targets.
• Other countries with new programs, new funding,
  or a rapidly growing culture of net use that can
  be converted to ITNs are within striking distance
  such as
• Senegal, Malawi, Zambia, Uganda, Rwanda, Guinea
  Bissau, The Gambia, Mali, Niger
• But still unlikely most countries in SSA can
  reach 60 by end of 2005

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Promising pathways

• Integration of free ITNs or ITN 100 redemption
  vouchers with other service delivery points
• Measles malaria (periodic campaigns)
• National immunization days (periodic campaigns)
• Child health days (periodic campaigns)
• EPI (continuous routine distribution)
• ANC (continuous routine distribution)
• Converting huge standing crop of untreated nets
  to LLINs
• Technology suitable for campaigns soon available
• Other targeted subsidies
• Social marketing through health services and
  private providers
• Commercial distribution incentives

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GFATM ITN projections

• Global Fund allocations in Rounds 1-4 can
  support distribution of on average 20 million
  nets per year over a five year period

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LLIN Manufacturing capacity is catching up to
global demand
Source UNICEF
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The number of countries ordering LLINs has
increased tenfold over past 4 years
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Challenges and pending issues
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Forecasting demand for ITNs/LLINs

• Need for timely country level forecasting /
  planning
• To reduce current lead times (6 months)
• To match campaign schedules and deadlines
• To assure supply matches demand
• To have buffer stocks of LLINs to compensate for
  routine demand

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Only halfway on taxes tariffs

• RBM needs to remind heads of state about their
  Abuja undertakings on taxes tariffs

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ITN scale-up challenges

• National-scale delivery mechanisms
• Comparative
• cost
• effectiveness
• feasibility
• system wide effects and
• sustainability
• in differing systems not yet known
• We need to learn systematically from on-going
  experiences
• Tendering procurement procedures for large
  scale operations still too slow
• Country generated and adapted solutions sometimes
  overlooked increasing tendency towards external
  imposition, single solutions and
  one-size-fits-all
• Major advocacy/communication gaps much
  misinformation

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Other WIN recommendations observations for the
Board

• Linkages among WGs and between WGs and SRNs need
  strengthening
• WIN products not widely disseminated need
  increased advocacy
• Potential role of ITN champions should be
  explored
• Consider distributing the RBM website on CD-ROM
  to country partners quarterly
• Board could raise the issue of taxes tariffs
  with the African Union
• MMSS could consider the development of integrated
  forecasting tools for ITN demand
• MMSS could consider documenting best practices
  for tendering and procurement of ITNs
• MMSS should consider raising the issue of bid
  bonds and their effect on production and supply
  of ITNs for follow-up with the World Bank and
  World Trade Organization

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Support for WIN

• WIN continues to function largely via the
  initiative and momentum of the partners.
• Largest and most active partnership working
  group.
• Partnership is satisfied with Secretariat at WHO.
• WINs Purpose, TORs, work plans, budgets and
  products need support of the RBM Board.