POST 00778E : MEASLES CAMPAIGN AND ITN DISTRIBUTION
Follow-up on Posts 00763E, 00765E, 00767E, 00768E, 00771E and 00774E
18 April 2005
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Mike Favin (mailto:
[email protected]) of the Manoff Group in the
United States has found this story on BBC News Online. "Malaria Wedding Net
Dress Decline : A campaign in Uganda to stop brides using cheap bed nets as
wedding dresses appears to be having an effect."
http://news.bbc.co.uk/go/em/fr/-/2/hi/africa/4393375.stm
This posting contains three contributions. The first from Rebecca Fields
(mailto:
[email protected]) from AED in the United States writing to David
MacGuire, Director of Netmark in the same organization, reminds us clearly
of the positions of the two sides to this discussion. The second is David's
reply (mailto:
[email protected]).
Thirdly, Robert Steinglass (mailto:
[email protected]) from
ImmunizationBasics in the United States, contributes further comments.
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David,
Currently, there is quite a bit of attention being given to the
distribution of ITNs during mass measles campaigns. Some
people--especially those who are major proponents of measles campaigns in
the first place--are very enthusiastic about this approach.
Others, e.g., Mike MacDonald, feel that it falls far short of what is
really needed, in that the campaigns serve merely as a distribution
mechanism while overlooking many other important program elements to get
ITNs used and maintained correctly. Issues of social marketing of ITNs,
and their commercial distribution have also come up in this debate.
Robert has been in the thick of these discussions, so if you have any
particular reactions or insights, I'm sure he'd greatly appreciate hearing
from you.
Rebecca
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Rebecca and Robert,
We actually worked with IFRC in Zambia on a targeted subsidy scheme to get
ITNs to mothers and their children during a vaccination campaign in
Kalalushi. We used vouchers rather than nets, gave them to women to redeem
in nearby outlets. There was over 97% redemption. The great thing about
this approach is that it got the nets in the hands of vulnerable
populations in a very targeted way while simultaneously helping to expand
outlets into fairly rural areas.
In principle I think this is an approach that could work. However, getting
the vaccine teams involved in managing the logistics of a highly bulky
product on a massive scale could detract from their primary function of
getting kids immunized and could also discourage commercial expansion of
outlets which is needed for sustainability.
I would also agree with Mike that there is a general lack of understanding
from the proponents of this approach in terms of the behavior change
communication that is needed to ensure correct use. You can't just hand
people nets and expect that they will understand why/how to use them.
Another thing to consider is something that happened in Ghana where Rotary
and ExxonMobil supported the distribution of nets during a vaccination
program. The people loved it. However, when those in neighboring
communities heard about it they demanded nets themselves. When they were
told that no other nets were available some refused to get their kids
vaccinated in protest. This was a story we heard from an MOH person who
felt that it was ok on a small scale but unrealistic to think that nets
could be handed out to everyone. It would end up being a logistical
nightmare that could have a negative impact in the end, and would be very
costly.
If you want to discuss this in further detail I would be more than happy.
David
David McGuire
NetMark Director
Academy for Educational Development
Washington, DC
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The campaigns have achieved impressive results. My biggest concern remains
the support for follow-up in between these high-visible externally-funded
and popular initiatives. You seem to assume that this support is a given.
But look at what has been the experience in the field in immunization:
after the polio or measles campaigns, the necessary support (technical,
financial, communications, etc.) for strengthening the routine immunization
program has not been forthcoming. As I mentioned earlier, the polio
eradication program has never even adopted an indicator as part of their
accelerated disease control program to track the performance of the routine
program; and in fact they have resisted to do so.
Campaign success instead is unfortunately measured by what happens to
coverage during the campaign and not in between campaigns. The interest
surrounding the campaign is used primarily to build up disease surveillance
(a good thing), but when continuing outbreaks occur, it is the weakness of
the routine system that is blamed!
My point is that the malaria control proponents who are concerned with
longer-term control must hold the feet of the campaigners to the fire
(i.e., hold them accountable) and insist that negative consequences of
campaign approaches are anticipated as best as possible and that measures
are put in place before the campaigns to increase the likelihood of
positive spinoffs from the campaigns for the sustainable longer-term
control of malaria. What planning is being done systematically on a country
by country basis (other than which country still needs which supplies and
funds for tomorrow's campaign) to ensure that the capacity is being built
and barriers are being overcome so that malaria will be controlled over time?
Regards,
Robert
Robert Steinglass
Technical Director
IMMUNIZATION Basics
JSI Research & Training
Arlington, VA USA
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