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Mid-distribution weekly reports for Dedza distribution, Malawi


Weekly reports during a distribution keep us informed of progress and any issues.

Dedza distribution of 245,000 nets, Weeks 1 to 4
  
Summary
 
Good progress, 139,549 nets distributed so far. The distribution is going well with no major issues.
 
Challenges

We encourage our partners to not hold back on reporting negative occurrences as we understand things can go wrong and plans have to adapt. We are obviously interested in the scale of any issues but are often more interested in how issues are resolved.
 
Concern Universal Malawi has been impressive in being entirely transparent with their reports and it is one factor that has led us to work with them repeatedly.

The challenges faced so far have been:
 
1. An isolated incident of 300 nets missing from one storage location. This is being investigated and pursued with the police as any nets missing is taken very seriously. 300 nets represents 0.12% of the total nets being distributed.
 
2. An inability to distribute nets in a number of villages, and the need to reschedule a net distribution, due to: 

  • misplacing villages in the wrong distribution clusters leading to an incorrect number of nets at a distribution point (being addressed through improved checking)
  • a lack of communication by local health workers to village leaders (this is being addressed)
  • some villages busy with elections, weddings or initiation ceremonies that were foreseeable (being factored into the timing of the distributions in the remaining villages)
  • deliberate duplicate registration of some beneficiaries (the nature of our verficiation procedures catches this sort of activity and the registration data was corrected)
  • issues with the identification of some beneficiaries due to illiteracy (resolution achieved with assistance from the village leader)
The above issues are considered by CU and AMF to be avoidable and lessons will be learned from them.
 
The following issues are considered to be largely unavoidable and are elements that have to be dealt with as they arise:

  • a truck breakdown
  • funerals taking place involving a significant portion of the village (sometimes a distribution can be moved to a nearby village; often a rescheduling is required)
Finally, a comment in the Week 1 report:
 
"Many villagers demonstrated their appreciation regarding the manner in which the net distributions were conducted, which they described as the most transparent ever done. This was achieved due to the involvement and participation of the local leaders and provision of a copy of the distribution register to the respective village head."


Balaka, Malawi, 6-month post-distribution check up report added


The key results from the post-distribution check-up (PDCU) of net use and condition are:

- 87% of nets hung, 70% in ‘very good’ condition. 25% in ‘OK’ condition
- 4,530 households (5% of those that initially received nets) and 7,977 nets were surveyed
These are strong results.
 
We publish the full PDCU results and the PDCU Report as well as the PDCU Planning Document on the Balaka distribution page.
 

396,900 nets on the way to Dowa District, Malawi


396,900 nets have shipped and will arrive in Dowa district in the middle of November for distribution from Dec14/Jan15 to protect 720,000 people and achieve universal coverage.

Our distribution partner Concern Universal will carry out the distribution.

AMF is funding both net and non-net costs, as was the case with the Balaka (2013) and Dedza (2014) distributions. We describe publicly the circumstances in which we cover non-net costs for a distribution.

A cost-driver led budget has led to detailed costings and we publish full budget details. Actual costs will be published at the end of the distribution.

The non-net cost per net is US$0.97. This covers shipping, pre-distribution activities (a district-wide household level registration to establish sleeping space net need), distribution and post-distribution follow-up (six, six-monthly check-ups of 5% of households, randomly selected and visited unannounced, carried out for three years post-distribution). 


Ntcheu, Malawi 33-month post-distribution check-up will start on 13 Oct 14


Monitoring net use and condition is an important element in optimising the protection of a population at risk from malaria.
 
This will be the fourth post-distribution check-up (PDCU) of net use and net condition in Ntcheu, Malawi following the June 2012 net distribution that achieved district-wide universal coverage of the population of some 550,000 people.
 
To date the results have been strong and we are keen to see the usage level and condition of the nets 33 months after they were distributed.
 
9,500 households, representing approximately 7% of those that received nets 33 months ago, will be randomly selected and visited unannounced.
 
The results will assist the District Health Officer (DHO) and National Malaria Control Programme’s (NMCP) decision as to when a re-coverage campaign should be conducted in Ntcheu so the people of Ntcheu remain protected.
 
 

Distribution of 676,000 nets underway in Kasaï Occidental Province, DRC


This distribution will achieve universal coverage in seven Health Zones in the Kasaï Occidental Province of Congo (Dem. Rep.), across a population of some 1.2 million people.

The distribution is being carried out by IMA World Health, with the UK Government’s Department of International Development (DFID) as a co-funding partner.

This will the first stage of a two stage net distribution approach that has the specific objective of maintaining sleeping space coverage at or above 80% for a period of four years.

The second stage will involve continuous monitoring of net use and condition, and also net gaps, with additional net distribution as appropriate via 'routine distribution' mechanisms.

In addition, 6,000 nets will cover all hospital and maternity beds across all health facilities in the seven Health Zones.

 


Distribution of 245,000 nets underway in Dedza district, Malawi


245,000 nets are now being distributed in Dedza district, Malawi. All nets will be distributed by the end of October.
 
These nets will protect some 440,000 people, helping to achieve universal coverage of all sleeping spaces in the district.
 
Pre-distribution work led by our distribution partner, Concern Universal Malawi, and carried out with the local government health teams, has involved visiting all 162,723 households in the district to establish net need per household. This allows an efficient, targeted distribution with each household receiving the number of nets each needs.
 
more

Behind the scenes


We have added Behind the Scenes to the Transparency section of the site.
 
We show this information to be transparent but also for those who might be interested in some of the things that go on behind the scenes in managing the charity.

Many of AMF's systems are automated. This means many activities are handled very efficiently requiring only a few minutes of oversight each month. Importantly, it also means we are able to do things we would otherwise not be able to do because they now require minimal resources. 
 
Topics we have covered, many of which include live data, are:

  1. Allocating donations to distributions
  2. Reporting on Post-Distribution Check-Ups (PCDUs)
  3. Managing Gift Aid
  4. Converting and locking all donations in US$
  5. Sending personal thank yous to donors
  6. Monitoring new donations 


An update on distributions being assessed


We have just updated our future distributions page showing the progress made in approving seven distributions. 
 
In the coming several months we will be parallel assessing a number of distributions of 1 to 2 million nets in size and possibly one of 3 to 4 million nets in size.
 
You can view the current status of each distribution with visual and summary updates.
 
 
 
 
  
 
 

Distributions update, June 2014


We have made a US$6m commitment to four distributions in Malawi over four years and on Idjwi Island, DRC. The same level of accountability, achieved through distribution verification and post-distribution follow-up, applies to these as to previous distributions.

A provisional, large distribution in a province of the DRC will not proceed as the distribution agent was unable to agree to the process requested by AMF in the timeframe needed by our co-funding partner.

Of the $14.8m in-hand, we have now confirmed spending of $8m leaving $6.8m for further distributions.

Approved distributions

1. Malawi

This set of distributions extends AMF’s planning horizon, increases the number of districts within which AMF will take responsibility for mass distributions and allows us to continue monitoring net use and malaria data in the coming years.
 
We have made a US$5.6m commitment to four distributions over four years in Malawi totalling 1.4 million nets to protect 2.5 million people.
 
  • Dowa District, November 2014, 400,000 LLINs
  • Ntcheu District, October 2015, 350,000 LLINs
  • Balaka District, October 2016, 235,000 LLINs
  • Dedza District, October 2017, 430,000 LLINs
The addition of Dowa district brings to four the number of districts (of 28 in Malawi) where AMF is responsible for funding.
 
Our distribution partner Concern Universal has demonstrated the commitment and capability to carry out successful mass distributions achieving high rates of net coverage in our previous work in Malawi. We will continue to use the same distribution methodology.
 
The timing of these distributions reflects the expected life of nets in these districts following the initial 2012 (Ntcheu), 2013 (Balaka) and 2014 (Dedza) work. Returning to these areas allows efficient monitoring of net use and collection of malaria data. Our processes are continually revised to ensure the most effective results.
 
The precise number of nets will be calculated on completion of the household level pre-distribution surveys.
 

2. Democratic Republic of Congo (DRC)

120,000 nets will achieve universal coverage on the island of Idjwi in eastern DRC
  
AMF has approved a 120,000 net universal coverage distribution on Idjwi Island working with Amani Global Works (AGW). A 60,000 net distribution will take place during November 2014 in North Idjwi. We have been impressed with AGW's experience in North Idjwi and their commitment to accountability and transparency. Both parties will review the North Idjwi distribution once completed and intend to carry, out shortly thereafter, a similar universal coverage distribution in South Idjwi.
 
Provisional distribution not proceeding
 
We are not proceeding with provisional plans for a third and larger distribution in DRC. Within the timeframe needed by our co-funding partner, the distribution agent was unable to agree to the process requested by AMF. While we remain ready to adapt our practices to different environments, we are seeking to improve on standard net distributions. This is because we have found significantly higher levels of hang-up when these improvements have been implemented. 
  
We fully understand that not all distribution partners will share our priorities or wish to make changes to their normal routine. After extensive discussions we did not reach agreement on the detailed aspects of verification of the distribution or monitoring and evaluation within the timeframe necessary to secure a firm commitment from our co-funding partner. During the negotiation, significant budget cuts were also placed on our co-funding partner.
 
This was intended to be our largest DRC distribution after the successful conclusion of negotiations for the distribution of 676,000 LLINs earlier this year with a different distribution partner, IMA World Health. These took one month and  included swift agreement on distribution verification, monitoring and evaluation. AMF and IMA believe that the detailed follow-up checks which have become a feature of AMF work significantly improves net hang-up rates.
 
We recognise this can and should be adapted to take into account the country and regional requirements, so detailed discussions will sometimes be necessary to find an agreed outcome. However, we are reviewing this experience to learn from it and in particular assess how to reduce the risk of important differences arise late in the process. A Letter of Partnership Principles was agreed by the three parties at the start of discussions, which included a clear commitment to the inclusion of monitoring and evaluation activities. This did not prevent differences being raised on these issues late in the process.
  
We are also considering whether future distributions should focus on three to four distributions of one to two million nets each rather than a large distribution that would require all of AMF’s available funds. This would allow AMF more flexibility to exit discussions earlier if differences arise.
 
 

Encouraging early stage progress with candidate malaria vaccine PfSEA-1


There is encouraging news about progress with a potential malaria vaccine, PfSEA-1.
 
A study in Tanzania took regular blood samples from a group of 1,000 children living in a highly malarious area, in the first years of their lives. 6% of these children developed a naturally acquired immunity to malaria. They produce an antibody that attacks the malaria-causing parasite.
 
What is particularly interesting about this candidate vaccine is the source of the compound being investigated: antibodies found in humans. This is different from many candidate vaccines which do not have a ‘starting point’ in humans. This may be an indication of a higher probability of a positive outcome at the human trials stage where proof is required of both the efficacy and safety of the vaccine.
 
The research team said they were encouraged by the results but stress more research is required. Trials are now needed in primates and humans to fully assess the vaccine's promise.
 
 

Malawi, Balaka District: net use assessment 6-months post-distribution


The 6-months post-distribution net use check-up (PDCU) is currently being conducted in Balaka District, Malawi.  Five percent of households, randomly selected, across 14 health centre catchment areas in the district were visited, unannounced, to assess net use and condition.

The data are being entered in Malawi now and may be viewed in real-time. As soon as all data have been entered we will publish a summary of the results.

The specific nature of the data - at the health centre level - means the District Health Officer (DHO), health centre leaders, community leaders and other health workers are able to decide what targeted malaria control intervention might be appropriate in specific areas. In circumstances where health systems and resources are stretched, information that assists with targeted interventions can help with effective use of resources and that is the aim of this information.

Background: Almost 160,000 LLINs were distributed in Balaka District in October and November 2013.


An interview about our evolution, principles and the distribution process


The latest issue of International Innovation features a three page interview with Rob Mather (founder, CEO), who discusses the way in which the charity evolved, our guiding principles and processes involved in distribution and monitoring the nets.

Download the article: 
Low-res version (329kb) or High-res version (8.4Mb)

See the original publication: International Innovation

 

 


AMF's Risk Register published


We have made public our Risk Register.

The Risk Register is an important document that allows us to list, rank, share and act as necessary to ensure AMF is doing the most it can to protect people from malaria. We list here the core, financial, IT, employee, board and compliance risks as part of our commitment to transparency and accountability. We monitor these risks on a continuing basis.

 

 


676,000 LLIN distribution agreed in the Democratic Republic of Congo (DRC)


AMF has agreed to fund 676,000 LLINs for distribution in the province of Kasaï Occidental. The nets will be distributed from July to October 2014 to protect approximately 1.2 million people.
 
The distribution is a partnership between AMF which will be funding all nets, the UK's Department of International Development (DFID) which will be funding all non-net costs through the ASSP (Access to Primary Health Care) project and IMA World Health which will be responsible for carrying out the distribution and post-distribution follow-up.
 
DRC is one of the two most affected malaria countries in the world. Large scale net distributions therefore have the potential to make a significant improvement to the health of the communities protected.
 
At the same time, operating in DRC is challenging given the recent conflict, poor infrastructure, minimal access to health care, difficult geography and long distances between towns and villages.
 
The distribution of nets and follow-up will be strongly data-driven. The distribution will be accompanied by detailed monitoring and reporting. Post-distribution check-ups of net use and condition will take place on a six to nine month rolling schedule for three years. The detailed planning of the distribution and follow-up will respect the practicalities of working in such a challenging environment as that presented by DRC.  
 
DFID has significant experience in operating in DRC, including funding large scale net distributions, and has in-country presence. IMA World Health has worked in DRC since 2000 and currently manages a series of significant health initiatives across five of the country’s eleven provinces. They have significant management experience of conducting large scale net distributions.
 
 
 

Ntcheu, Malawi - Strong continued net use and condition after 24 months


Summary
 
The Post-Distribution net use and condition Check-Up (PDCU) in Ntcheu, Malawi, carried out 24 months post-distribution, has shown an 81% hang-up of nets with 49% still being in ‘very good’ condition (up to two holes of up to 2cms in size). These are strong results. The sample size was significant: 9,100 households and 19,000 nets, representing 7% of the initial nets distributed and at least 250 households in each health centre catchment area.
 
Final information is being entered in Malawi and can be followed live, as it is being entered. We will continue to monitor and report on progress.
 
Detail
 
Equally as important as the initial coverage of a population with nets, is the continued use of the nets so they continue to protect a population and prevent malaria.
 
The challenging environments in which nets are distributed can lead to nets becoming damaged or worn out so the number of nets hung, and the condition they are in, will decline over time.
 
However, initial high levels of coverage, a community’s understanding of the importance of the use and good treatment of nets, as well as appropriate interventions by health leaders all contribute to optimising the impact of the nets.
 
Data showing the level of net use and condition allows an understanding of the actual net coverage as well as providing the District Health Officer (DHO) and Malaria Coordinator (MC) and their teams with information that can be helpful in deciding on additional anti-malaria related interventions and where to direct them. This is particularly valuable where resources are limited.

We track net use and condition via a series of ‘Post-Distribution Check-ups’ (PDCUs) every six to nine months that involves unannounced visits to a randomly-selected set of households across all health-centre catchment areas, representing 5% of those that received nets initially. This provides statistically significant and locally actionable information. It is time-effectively and cost-effectively gathered and collated through a partnership between AMF, the local distribution partner and the local health teams. The information is immediately available to local health leaders.
 
Malaria is the, or one of the, most significant health issues in the areas in which nets are distributed and nets are the most effective method of prevention. Understanding the level of net coverage in the extended period after a mass distribution, and working to sustain high levels of net coverage justifies in our view the modest investment of time and money in collecting this data.
 
‘Universal coverage’ is used here to mean all sleeping spaces covered. A goal of some mass distribution programmes is 80% initial sleeping space coverage. We, and our partners, believe higher levels of coverage should be the aim and are achievable. We present and colour code the PDCU data on the basis that 90%, 85% and 80% coverage after 6 , 15 and 24 months represent a ‘very good’, and therefore the desired, outcome.
 
 

Malawi, Ntcheu District: net use assessment 24-months post-distribution


The 24-months post-distribution net use check-up (PDCU) was conducted in Ntcheu District during December 2013/January 2014.  9,250 households across all 37 health centre catchment areas in the district were visited, unannounced, to assess net use and condition.
 
The data are being entered now and may be viewed as they are being entered in Malawi.
 
As soon as all data have been entered we will also publish a summary of the results.
 
The specific nature of the data - at the health centre level - means the District Health Officer (DHO), health centre leaders, community leaders and other health workers are able to decide what targeted malaria control intervention might be appropriate in specific areas. In circumstances where health systems and resources are stretched, information that assists with targeted interventions can help with effective use of resources and that is the aim of this information.
 
Background: 270,000 LLINs were distributed in Ntcheu District in January to March 2012. A 6-months post-distribution check-up of net use and condition was completed in June/July 2012 and a 12-months post-distribution check-up completed in April/May 2013.
 
 

US$22 million milestone passed!


We have now passed the US$22 million mark - thanks to a donation from Burbank California, USA - and also had our 80,000th donation too - from San Diego!
 
Our sincere thanks to everyone for their support and generosity and best wishes for 2014.
 
You can see all our milestones on the website.
 
 

What Would You Do If A Stranger Handed You $100?


The Life You Can Save has offered thousands of dollars to strangers on the street and gave them a choice: they could keep the money and run, or hand it over to charity! See what happened in the video below and take part in their giving game too! 


Nightmare: Malaria exceptionally well received and reviewed!


The Nightmare: Malaria game developed by Pysop Games has been exceptionally well received and reviewed! It was downloaded more than 160,000 times across 181 countries in its first ten days (wow!) and is now nearing a quarter of a million downloads, been featured in the iTunes US App Store and on FastCoCreate, and been reviewed by AndroidPolice.

 

See: iTunes App StoreGoogle Play store and Kindle Fire

 


Future distributions update


Future distributions    
We have made significant progress with assessing four distributions totalling 5.87m nets and expect to provide a formal update with details by the second week in February.

Additional funding
We are presently seeking funding of an additional $5m to be able to fund fully those distributions currently being discussed and requiring a decision before the end of March 2014.
 
 

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