 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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