In late 2019, PSI Mali began coordinating with the Malian National Malaria Control Program (NMCP) and Ministry of Health (MoH) to plan for the country’s next insecticide-treated net (ITN) mass distribution campaign with financial backing from the Global Fund to Fight AIDS, Tuberculosis and Malaria. They aimed high, looking to distribute 7.8 million nets—enough for about one-third of Mali’s population, based on the universal coverage goal of one ITN per 1.8 people—which all needed to be distributed before the start of the summer rainy season.
The Global Fund considers Mali a complex operating environment (COE) due to its current security situation, which means there is a need to be adaptive in planning and to have extensive risk contingency plans in place. And when Mali confirmed its first case of COVID-19 on March 25th, the country faced another hurdle—how to adapt the mass net distribution campaign to the constraints of a pandemic. When this first case was diagnosed, it didn’t erase the threat of malaria for Malians; in fact, it compounded the danger malaria presents for the millions of people living in malaria-endemic countries.
So instead of running its net distribution campaigns region by region as originally planned, PSI Mali changed course to distribute all 7.8 million nets from June to early July in four regions: Kayes, Kouilkoro, Mopti and Sikasso. By the end of June, 98% of the nets had been distributed to households free of cost, keeping them safe from malaria through the rainy season.
So how did PSI Mali complete such a large campaign with the added burden of the COVID-19 pandemic? PSI is no stranger to distributing nets in difficult environments, but each country presents its own challenges and opportunities. Below are three tactics that helped PSI Mali and the NCMP reach its distribution goals.
- Adapting COVID-19 prevention into a mass net distribution campaign
PSI Mali quantified the number of nets it needed to distribute using existing data and later confirmed its estimates with a registration phase during the campaign. PSI typically distributes ITNs from a fixed-point of distribution (such as a community center or clinic) where households gather to pick them up with vouchers distributed during the registration phase.
To avoid large gatherings and the potential spread of disease they bring, PSI Mali came up with a dual strategy for distribution. In urban areas, nets were distributed door-to-door as recommended through global guidance documents. Distributors stopped in front of each household instead of entering and spoke with the head of the family to distribute nets. In rural areas, nets were still distributed from a fixed-point location with additional protective measures enforced, including physical distancing, handwashing and crowd control. Community village chiefs and other local leaders were engaged to ensure malaria and COVID-19 messaging reached the population, and explained how the ITNs would be allocated this year. In both rural and urban areas, a pre-determined ITN cap per household was used based on average household size, which was about 5 ITNs per household. This allowed the campaign to accelerate distribution, and minimized the risk of adding another touchpoint during the registration phase.
- Tracking data in real time
Mali is a large country, both demographically and geographically, with some areas of insecurity throughout the country. During the 2020 net distribution campaign, time and efficiency were of the essence to keep both health workers and the general population from prolonged exposure to environments that could spread COVID-19. Real-time data collection became critical so that the campaign could nimbly respond to changes in the pandemic, track how many nets were being distributed and how long it took to distribute them.
With DHIS2, an open-source web-based health information system used in more than 40 countries across PSI’s network, PSI Mali and the NMCP was able to track net distribution data in real time and make informed decisions about the campaign while implementation was still underway.
- Payment using mobile money
Technology also facilitated another crucial aspect of the campaign: payment. During previous campaigns, it could take a long time to pay health workers and distributors for their work due to the burden of individual cash payments, but mobile money transactions through Orange Telecom made it easy to pay a large number of campaign actors quickly. If work was completed early or late, they could adjust the payment accordingly. There were 30,000 paid ITN temporary staff mobilized for the ITN mass campaign and 150,000 transactions completed each month, creating a total of around US$2.3M transferred via mobile transactions. Mobile money also made it possible to travel without cash, further limiting danger to the distributors or other campaign actors.
There are many challenges present as the COVID-19 pandemic continues, but this hasn’t stopped malaria from threatening the lives of millions across the world. With the three tactics above and more, PSI Mali in coordination with the NMCP was able to fight malaria while also fighting COVID-19. The quick pivots to adapt to COViD-19 by the government and PSI Mali team helped to keep one-third of the population of Mali safe for the next three years from malaria. Congratulations to the PSI Mali team and the Malian government for their leadership and adaptive management of the ITN campaign this year to ensure this key activity was realized!