Nigeria Malaria Impact Evaluation

1
Nigeria Malaria Impact Evaluation
Launching the Malaria Impact Evaluation Program

• Claribel Abam
• Festus Okoh
• Ramesh Govindaraj
• Joe Valadez
• Iris Boutros
• Sebastian Martinez

2
Intervention

• Scale up of the coverage and use of LLITNs, ACT,
  IPT and IRS in seven program states
• Innovative demand and supply side approaches,
  with the objective of reaching 80 use of ITNs by
  vulnerable group by 2010.
• The impact evaluation design was focused on two
  areas of primary importance
• Delivery of LLITNs and ACT through private sector
  
• Ways of improving the implementation and
  performance of the alternative delivery
  mechanisms.
• Ways of improving coverage and use of LLITNs and
  ACT on the demand side
• Focus on
• PMV (Patent Medicine Vendors)
• RMM (Role Model Mothers) /TBA (Traditional Birth
  Assistant)
• CHW (Community Health Worker) /VHW (Village
  Health Worker)

3
Supply Side Policy Questions

• National Level (7 program states)
• What is the effect of delivery of LLITNs and ACT
  through the private sector (PMVs) on coverage and
  usage of LLITNs and effective anti-malarial
  treatment?
• Pilot Schemes
• What is the marginal effect of alternative
  incentive schemes on the performance of PMVs?
• What is the marginal effect of follow-up/ongoing
  training on the performance of PMVs?

4
Demand Side Policy Questions

• National Level (7 program states)
• What is the effect of Role Model Mothers (RMM)
  on the coverage/use of LLITNs and effective
  anti-malarial treatment?
• Pilot Schemes
• What is the effect of alternative incentive
  schemes to RMMs, TBAs and CHWs on the coverage
  and usage of LLITNs and effective anti-malarial
  treatment?
• What is the effect of follow-up/ongoing training
  to RMMs, TBAs and CHWs on the coverage and usage
  of LLITNs and effective anti-malarial treatment?

5
Indicators

• coverage of LLITNs
• use of LLITNs
• use of ACTs
• fever
• other maternal and child health outcomes
• socio-economic outcomes (labor supply,
  income/consumption, schooling, etc)

6
Evaluation Design - National

• Incorporation of PMVs and RMM through LGA level
  training activities over a 9-12 month period.
• Random roll out of training activities amongst
  LGAs across 7 project states
• Exogenous variation in the presence of PMVs/RMM
  (6-9 month exposure)
• Exogenous variation in exposure to treatment
  thereafter
• LGAs trained first constitute the treatment group
• LGAs trained last constitute the control group.
• Consider opportunities for randomizing at Ward
  level.
• Roll out of training activities commence by June
  2007.

7
Evaluation Design Pilot Studies

• Representative sample of evaluation communities
  or villages
• Random assignment of incentives to PMVs
• Random assignment of training to PMVs
• Random assignment of incentives to RMMs/TBAs/CHWs
• Random assignment of training to RMMs/TBAs/CHWs
• Unit of randomization likely to be the community
  or village

8
Sample and Data

• National
• LQAS Monitoring data
• 62 LGAs in 7 states
• Baseline already conducted in late 2006
• Follow up in early/mid 2008
• Power calculations needed to determine detectable
  effect size
• Pilot
• Primary household level data on representative
  sample of communities
• Sample sizes to be determined

9
Staffing Plan

• Impact Evaluation Team
• Impact evaluation experts (World Bank/IFS)
• Country team (National/State/LGA Malaria
  Programs)
• Local Academics
• Data Collection (National Bureau of Statistics
  NBS)

10
Timeline

• Short Run Activities
• Mid-May technical work to randomize roll out of
  LGAs (training of PMVs) followed by a
  videoconference
• June Workshop in Abuja for planning of national
  impact evaluation
• August Country level workshop for ME and IE for
  planning of pilot impact evaluations

11
Budget

• Short run expenses
• Mid-May expenses for videoconference meeting (1
  day, domestic travel for 15 people)
• Expenses for training in June (6 days, domestic
  travel for 15 people)
• August workshop (5 days, domestic travel for 15
  people, venue, etc)
• Budget TBD, aprox 100,000 for initial activities