Policy Brief: 3DE Evaluation on the feasibility and cost-effectiveness of community fixed-point distribution of malaria bednets in Zambia

In 2014, Zambia was planning to distribute 6-7 million insecticide-treated bednets (ITNs), but only limited information was available on the most efficient distribution and hang-up approach to optimize ITN ownership and use in Zambia. A door-to-door distribution strategy had been previously used throughout Zambia, but was highly challenging and costly in terms of time, supervision costs, and volunteer work burden. In order to inform decisions about using alternative methods, Zambia’s Ministry of Health (MOH) and National Malaria Control Programme (NMCP) requested an evaluation to assess the cost-effectiveness of community fixed-point distribution of ITNs compared to the current door-to-door strategy. CHAI’s Demand-Driven Evaluations for Decision (3DE) program conducted an evaluation that used observational methods were used to measure feasibility of community fixed-point distribution and randomized methods to assess the appropriate timing for follow-up door-to-door visits by CHWs to hang up unused ITNs.

This evaluation indicated that the community fixed-point distributions achieved ITN use and retention rates comparable to a well-run ITN door-to-door distribution while achieving significant time and cost savings. Ninety-six percent of households in the pre-registration survey attended the fixed-point distribution events or sent a representative. At seven to 11 weeks after the distributions, 90 percent of distributed ITNs were found in households and 74 percent of all observed sleeping spaces were covered by an ITN. When volunteers visited households following the fixed-point distributions, many families had already hung their ITNs, saving time and effort on the part of the volunteers. Specifically, 46 percent of distributed nets were self-installed five to seven days after distribution and 78 percent of distributed nets were self-installed 10-12 days after distribution. Based on these results, delaying CHW hang-up visits by 10 days or more could reduce the CHW ITN hanging workload by more than 70 percent.

According operational data gathered in the evaluation, community fixed-point distribution could reduce the CHW time required by approximately 25 percent. Based on this evaluation and data available from other door-to-door distribution campaigns, it was estimated that using community-fixed point distribution with delayed hang-up for distribution of all ITN in the 2014 mass ITN distribution campaign could reduce costs by almost US$1 million.
Read more about this evaluation in this policy brief or publication.