 What a great way to end the year! We have reached the 100,000th donation thanks to a donor in Sydney, Australia.
We have received donations both large and small and every $3 matters as every net matters. 100% of the funds we have received will buy nets and all donors will be able to see exactly where the nets they fund are distributed.
Our very best wishes for 2015.
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We have now passed the 25, 26, 27, 28 and US$29 million milestones, thanks to a significant US$5m grant from Good Ventures, the San Francisco based philanthropic foundation!
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 We are absolutely thrilled to have recently been awarded a US$5m grant from Good Ventures, the San Francisco based philanthropic foundation.
This is the largest grant AMF has ever received (previously US$1.25m, also from Good Ventures) and it will make a huge impact on fighting malaria, saving many lives, reducing illness and boosting economic growth.
It comes at an exciting time for AMF as we work to expand the number and scale of the projects we support. We have no doubt it will be pivotal.
Every single donation is important, no matter how large, in the fight against malaria. There is a huge gap between the funding available and the net need. We never forget that every $3 buys a net and every person covered by a net is potentially a life saved. There are now over 99,000 donations to AMF. Together we have built a community that will keep the fight against malaria high on the international agenda. We are aiming to secure a further US$20+m for the projects we are currently considering. Aside the occasional marvellous large donation, the majority of AMF’s funds come from donors giving less than $100 and we are incredibly grateful for every one of them.
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 We have just had the 99,000th donation thanks to a family in Normal, USA and we are looking forward to celebrating the 100,000th soon.
We have received donations both large and small and every $3 matters as every net matters.
100% of the funds we have received will buy nets and all donors will be able to see exactly where the nets they fund are distributed.
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 Giving What We Can’s (GWWC) December update confirms its list of recommended charities remains unchanged and we are delighted to continue to be included.
GWWC comment in their review of AMF:
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Ntcheu District (Population: 580,000) - Post-distribution Check-Up (PDCU) at 33-months just completed
The fourth PDCU of net use and condition has been completed, 33 months after the mass distribution of 268,420 nets in January 2012. The PDCU data, that could be followed ‘live’ as it was being entered in Malawi, is now in the final stages of being checked. The results are good. We will publish shortly a commentary on the results.
Dedza District (690,000) - Distribution nearly complete
245,000 nets have now been distributed protecting 440,000 people and achieving universal coverage in all distribution areas, bar one. Nets have been distributed according to household-level net need information gathered during a comprehensive pre-distribution registration survey (PDRS). The number of nets required for the final ‘mop up’ area is being determined now and they will be distributed early in 2015.
Dowa District (700,000) - Pre-distribution Registration Survey (PDRS) underway
Every household in Dowa district, some 165,000, will be visited over the next two weeks by 440 Health Surveillance Assistants (government health service staff) to assess the number of sleeping spaces, perfectly usable nets and therefore net need for each individual household. Supervisors will make unannounced visits to randomly selected households to monitor the accuracy of the data collected. The data collected will be put in electronic database form, cleaned, checked and passed to village and community leaders for a public reading to ensure no omissions or inaccuracies. The final list will form the basis of an accurate net distribution to ensure full sleeping space coverage is achieved with no material theft of nets. This process is managed and supervised by our distribution partner Concern Universal working in close partnership with the Dowa District Health Officer, Malaria Coordinator and District Executive Committee and their teams. 396,900 LLINs have arrived in Dowa and are now in secure storage awaiting distribution in January and February 2015.
Balaka District (400,000) - Post-distribution Check-Up (PDCU) at 12-months about to start
The second PDCU of net use and condition is in the final stages of planning and will commence shortly. 5% of the households that received the 154,230 nets in November 2013 will be randomly selected and visited unannounced to assess net use and condition. Supervisors will check 5% of households visited by each data collector to ensure data accuracy. For any PDCU we ask it be carried out within ± 1 month of the appropriate anniversary.
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We are currently in detailed discussions regarding four potential distributions in four different countries (total 2.76 to 4.76 million nets), and four potential distributions are at the information stage. We will provide updates on each as meaningful progress is made or decisions are taken.
You can see more details on our Future distributions page.
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We have now passed the US$24 million mark - thanks to a donation from Dunstone, United Kingdom!
We are also close to reaching our 100,000th donation and 500,000 fundraising participants. Our sincere thanks to everyone for their support and generosity.
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The 33-months post-distribution net use check-up (PDCU) is currently being conducted in Ntcheu District, Malawi. Five percent of households, randomly selected, across 37 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 as they are entered. 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.
We will provide our assessment of the data once all have been entered.
Background: 268,400 LLINs were distributed in Ntcheu District from December 2011 to February 2012.
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 AMF is delighted to announce Professor Hilary Ranson of the Liverpool School of Tropical Medicine (LSTM) has joined AMF’s Malaria Advisory Group (MAG).
The MAG advises AMF on many aspects of its activities including assessing target distribution locations and ensuring best practice in carrying out pre-distribution activities (including assessing household level net need and delivering malaria education), distribution management and verification, and post-distribution follow up.
Professor Ranson is one of the world’s leading authorities on insecticide resistance (IR). Hilary joined LSTM in 2001 and has been the Head of the Department of Vector Biology since 2010. She leads a portfolio of IR related research and advises widely on IR policy, including that relating to net distributions. She will be a very valuable addition to the group advising AMF.
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The operational plan for a distribution typically covers 12 months. The planning horizon for a specific distribution is, however, typically 18 to 24 months as discussions to assess and approve a distribution start six months earlier and the funds required (we need to have funds in hand in order to have serious discussions) are aggregated in the preceeding months.
For the distribution in Balaka (Sep/Oct 2015), recently announced, the sequence of operational steps (simplified) are:
Nov 14: Distribution (new timing) confirmed
Feb 15: Pre-distribution registration survey (PDRS, all households) planning document received
Apr 15: PDRS carried out, including verification activities and report received
Jun 15: Nets shipped (two month transit time)
Aug 15: Nets arrive in country, pre-positioned
Sep 15: Distribution of nets (Sep and Oct 2015)
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The Malawi National Malaria Control Programme (NMCP) will be coordinating a country-wide mass distribution of nets during 2015 in 24 (of the 28) districts in Malawi. This follows the nationwide mass distribution on nets in 2012 and is therefore a re-coverage campaign. This timing is consistent with the three year repeat cycle common to many national programmes matching the degradation profile and useful life of the nets.
As a result of discussions between the NMCP and the wider Task Force group, within which AMF and our distribution partner Concern Universal are represented, and which coordinates and manages malaria control activities in-country, it has been decided a re-coverage distribution in Balaka during 2015 is both the optimal action for protecting the people of Balaka and means the Balaka three year distribution cycle will be aligned with the rest of Malawi.
As a result, all specific donations to AMF that are funding this distribution which had been previously designated as ‘ underwriting donations’ (given it was considered likely an early distribution, elsewhere, and prior to Sep/Oct 2016 would mean the specific donations would be moved to fund an earlier distribution) have now been designated as ‘confirmed allocated’ and will fund the Balaka distribution.
Further information:
A partial coverage distribution took place in Balaka in June 2012 conducted by the NMCP. The 70,000 LLINs found in place via an AMF/CU-conducted district-wide audit of all households were supplemented by the distribution of 154,230 LLINs in October 2013 which achieved district wide sleeping spaces coverage. By September 2015 at least 70,000 LLINs will need replacing (to protect some 130,000 people) as well as an estimated 30-40% of the nets distributed in October 2013 (an additional 45,000 to 60,000 LLINs to protect some 80,000 to 110,000 people). In addition, nets that have less than 12 months life remaining will be replaced which is anticipated will increase the number of nets required by a further 50,000, and population growth will add an additional 10,000 LLINs for a total requirement of up to 190,000 LLINs.
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 A number of donors to AMF have recently added reviews to the Great Nonprofits website and we are exceptionally grateful for the comments people have made.
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AMF has agreed to fund 730,000 LLINs for distribution in North Ubangi district in Equatéur province to achieve coverage of all sleeping spaces (universal coverage) across all eleven of the district’s health zones. The nets will protect approximately 1.3 million people and will be distributed in the first half of 2015 with specific dates being determined now.
The distribution is a partnership between AMF, who will be funding the nets and shipping cost to DRC, the UK's Department of International Development (DFID) who will be funding all non-net costs through the ASSP (Access to Primary Health Care) project and IMA World Health who will be responsible for carrying out the pre-distribution, distribution and post-distribution follow-up activities.
This is the second such co-funding and distribution partnership between the three organisations, following that in Kasai Occidental province to distribute 676,000 nets during August to November 2014.
DRC is one of the two most affected malaria countries in the world. It is estimated some 500 people per day die in DRC from malaria. 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.
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Summary
Our distribution of 676,000 nets in Kasai Occidental in partnership with IMA World Health (IMA) is our first one using smartphone technology for data collection. We see this as an exciting development with significant potential benefits including:
- Acts against potential theft
- Improved accountability
- Greater transparency
- Greater data accuracy
- Improved cost effectiveness
- Additional data can be collected
- Reduced operational risk
The use of this technology may become a significant determinant of future net distributions that we fund. We will report publicly on our experience with the Kasai Occidental distribution and the data gathered.
Detail
IMA is using smartphones and open source software (which is free) to manage the data collection associated with the distribution of 676,000 LLINs in Kasai Occidental in DRC.
Gathering household level data, primarily the number of sleeping spaces in each household, but potentially the number of people and perfectly usable LLINs, as well as other profile data, is necessary if the aim is coverage of all sleeping spaces in a distribution zone.
Paper based data collection is a common approach. However, if the data is not subsequently put in electronic form, it is difficult to check independently and monitor. There can be data loss risks if copies are not made and copying many thousands of pieces of paper can be challenging and costly. If data is put in electronic form, data-checking and sharing for independent monitoring can then happen. This latter approach has been our way of operating.
The use of smartphone technology, with data uploaded daily via wifi at health centres, removes many steps in the data management process and facilitates sharing of information. Early indications are of significant cost savings versus paper based gathering.
GPS information can also be gathered helping to locate households and tie the number of nets delivered to each.
Use of this technology has the following potential benefits:
- Acts against potential theft
- Detailed household data underpins a distribution making theft at all levels difficult/potentially immaterial
- Improved accountability
- Data captured at registration and distribution is easily accessible and underpins post-distribution monitoring
- Greater transparency
- Easy to capture data which can be shared widely, including publicly
- GPS data offers engaging/effective way of sharing information with donors using maps
- Greater data accuracy
- Simple data entry via tap screen, with quantitative and menu-driven answers
- Error checking as data entered (for example, if more nets hung than sleeping spaces recorded, error shown)
- Improved cost effectiveness
- Fewer data management steps
- Assuming familiarity with smartphones, minimum training is needed to use the data collection app
- Open source software, so free. NB: Other commercial systems may be expensive and our sense is this has inhibited uptake.
- Additional data can be collected
- GPS data recorded for each household with ~6 metre average accuracy
- Photos of household/householder/nets
- Reduced operational risk
- Lowers/removes risk of costly problems through data loss when only one paper copy of data exists
Our understanding is that few are using this technology at present. The reasons may be two-fold. First, until recently most technology-led data collection solutions were supplied by commercial companies and were costly, inhibiting uptake. Second, some believe the collection of household level data in not necessary, and is either prohibitively expensive or operationally difficult. We would disagree on both counts. We do expect there may be teething problems with the use of the technology and we will report openly on what we find.
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We link individuals donations to specific distributions so donors can see where the nets they fund are distributed, and to keep donors apprised of progress we send each donor a small number of emails relevant to their donation over the course of a distribution.
Currently, some 7,500 specific emails are being sent to a similar number of donors to let them know about the allocation of their donation to a distribution or update on progress with their distribution. The image above shows the progress of the emails at the time of writing.
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Summary
Our distribution budgets are cost-driver based as this helps achieve accurate budgets and aids cost management. We publish them as we wish to share with donors how we spend funds entrusted to us.
Detail
Cost-driver based budgets are by their nature highly detailed. Each cost line is developed from elements that determine it. For example a ‘fuel cost’ budget line item would be calculated from the number of vehicles multiplied both by the expected litres of fuel per day and the cost of fuel per litre. Similarly an overall ‘transport cost’ would be developed from a similar approach to the expected cost of truck drivers and of vehicles, with all three items added to determine the overall transport cost.
The benefits of this form of detailed costing to the overall management of our net distributions are:
- Helps with cost control and also ensures the work that needs to be done is fully costed
- Assists clear communication with our distribution partners and the use of templates minimises as far as possible the time the distribution partner spends on necessary administration easing as far as we can their workload
- Aids transparency with donors and others as to how we are spending funds entrusted to us
- Improves future budgeting through a close understanding of actual costs and how they break down
In environments where there is the potential for cost management to be challenging, and this is true of the areas in which net distributions are conducted, attention to detailed budgets and following up on actual costs, and publishing them, is very important.
It is a strong indication to us when we build a relationship with a distribution partner, to whom we entrust many millions of dollars of nets, there is a willingness to work with cost-driver based budgets and to report on actual costs.
We see achieving efficient use of funds as an obligation and, given the substantial sums involved, this approach helps us to do our best to meet that obligation.
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Summary
We have updated the layout of our non-net costs section and added significant budget and actual cost information.
Details
We publish two levels of non-net cost information:
1. Summary level budget and actual cost information per distribution, which can also be viewed by project element for each distribution on the webpage. Project elements are: shipping, pre-distribution, distribution and each post-distribution check-up intervention.
2. Detailed cost-driver led budgets, showing actual and budget cost comparisons in excel documents.
We publish this information as we wish to share with donors how we spend funds entrusted to us.
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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."
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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.
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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).
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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.
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.
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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.
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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.
This pre-distribution activity allows significant engagement of community and health leaders in the net distribution process and associated malaria education elements. Community involvement is instrumental in ensuring an organised distribution and helping to achieve high levels of immediate net hang-up and sustained use.
Detailed distribution records, including household level data, will allow us to verify nets were distributed as intended. Independent supervision at the ‘moment of distribution’ ensures no nets are misappropriated.
The data collected during the pre-distribution phase will be used in the six-monthly post-distribution net use and condition check-ups, when 5% of households are selected at random and visited unannounced to gather net use and condition data. These (anonymised) data are made public, allowing us to report on the levels of net use achieved over time. The District Health Officer (DHO) and his/her team are able to use this health-centre level information to influence additional local malaria control interventions as they deem necessary.
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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:
- Allocating donations to distributions
- Reporting on Post-Distribution Check-Ups (PCDUs)
- Managing Gift Aid
- Converting and locking all donations in US$
- Sending personal thank yous to donors
- Monitoring new donations
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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.
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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.
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 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.
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