How We Make Decisions

When deciding to fund nets for a distribution, we look for two things: areas with a malaria problem where there is also a need for nets, and distribution partners with whom we are comfortable working.

There is reliable information showing where malaria is a problem. We liaise with a variety of groups, including national malaria control programmes (NMCPs) and other organisations funding nets, to establish where there is a net gap. This helps us identify areas we then investigate further. 90% of the deaths from malaria occur in sub-Saharan Africa, and this region is the main focus of our activities. Malaria is also present in parts of Asia and other countries within the tropics, and we do work there too.

There are four operational elements to a distribution we consider important. We discuss these elements with potential distribution partners, and if they share our approach to a distribution, we are keen to work with them:

1. Accurate household-level net need data: Number of sleeping spaces and existing usable nets. This helps us know exactly how many nets each household needs. Distribution partners typically carry out a pre-distribution registration survey (PDRS) across the entire distribution zone to establish the number of sleeping spaces and the number of LLINs with at least one year of remaining use.
2. Independent supervision at the 'moment of net distribution': Individuals not connected with the communities receiving nets or the government health teams involved in the distribution are present whenever a net is handed out. They check the beneficiary's identification on the net distribution list and ensure the 'no show, no net' rule is applied.
3. Post-distribution monitoring of net use and condition: Data showing the level of net use and the condition of the nets. Post-distribution surveys (PDSs) are carried out at six-month intervals, assessing approximately 5% of the distributed nets through visits to randomly selected households. The data are published.
4. Monthly malaria case rate data: Monthly malaria data is gathered from all health centers in the distribution zone, including monitoring the level of stock of rapid diagnostic testing (RDT) kits. This allows us to assess the impact of the nets and be alerted to any trends that might suggest additional actions are necessary. The data are published.

These elements are addressed in an assessment process that has a number of stages:

• Is the area high risk for malaria, and are we confident in the data?
• Is there a need for nets, how many, and are we confident in the data?
• Are there insufficient funds from other areas to meet the net need, and are we confident in this information?
• Would nets be distributed in a mass campaign (as opposed to routine distribution)?
• Would the National Malaria Control Programme (NMCP) agree to the four main requirements we have of a distribution?
• Are there potential distribution partners with the necessary resources and experience with whom we could collaborate?
• Is there a strong leader in charge of the distribution partner(s) with whom we feel we can work closely?
• Would the distribution partner(s) agree to the four main requirements we have of a distribution?
• Can we agree on when the nets would be distributed?
• Are non-net costs for the project in place?
• Do we both feel comfortable to proceed?

We add information showing progress with each future distribution we are assessing.