Insecticide treated nets programme:experiences from an on-going programme within the context of health sector reforms in Morogoro Rural District

Abstract

ITNs programme for malaria control is a new intervention in the health sector. It is a programme that needs a lot or consideration in terms of resources and managerial capacity.lluman resources. required materials, adequate 'financial support and planning are necessary for a successful programme. Dl IM'Ts are still in a transitional phase with no experience in implementation of such a programme. Hence. they arc likely to face initial hurdles and challenges. This wus a cross-sectional study and descriptive in nature employing quantitative and qualitative methods. In total. 21 U mothers in each randomly selected households and 1 Y programme implementers were interviewed. From these 210 mothers and 1 Y implementers. information was obtained that was complemented with in-depth group and individual interviews. Of the six implementers interviewed at district level, all said that the ITNs and insecticide supply was irregular. These implementers' view was supported by two out of Iive of village health workers. 1\11 19 all implementers interviewed at all levels reported that lEe messages about ITNs and their treatment were conveyed to the community and different message channels were used such as billboards, posters, stickers, and T-shirts. Others were health education. meetings and house to house visits. All the 19 implementers interviewed kept records and 84% of them reported that they were supervised in the last 3 months. - - ~ - - ---- - ~ ------~----- \111- Among the 3 villages. the 100\Tst proportion of ITNs use (.58. ()'frJ ) and re-trcuuncnt rate (18HT) ill the last 3 mouths \Vas Iouud in Fulwc village which is .5 km from a health facility. The facility is the main source of the items. The pattern was different in the other villages whose source of items was within their vicinity. Among the mothers who were the users of ITNs, the age group of 16-35 years had the lowest re-treatment rate. About 63% of these mothers, their nets were not treated in the last,) months. This also applied tu the unmarried mothers who had the lowest use of ITNs and re-treatment rate. About 7 L % of their nets were not treated in the last 3 months. Among the users of ITNs. the 1110thcfS with above primary education level had the highest use of ITNs and rc-treuunent rate. About 100% re-treatment rate was found in mothers with college education while the lowest re-treatment rate (33.3%) was found in mothers with no formal education as well as with incomplete primary education. The majority of the interviewed participants in both groups and individual interviews were aware that mosquitoes and poor environmental sanitation was the cause of malaria and that many people nowadays do use lTNs than in the past before the start of the programme. Those interviewed were of the opinion that the implementers were pcrtorming their work well. They also expressed the views that the few who arc not using lTNs were doing so because of inadequate cash in the families. The majority of the groups and individuals interviewed suggested that more mobilisation uf the people is needed to sustain the ITNs and their treatment in the community. ' . • ....•• ~.

To a large extent the programme in its initial phase has performed well in creating an enabling environment For the use of ITNs. The programme is on- going and the potential for achieving the laid down objectives is high. There are some areas that require more efforts For improvement hy the implementers, such as the constant availahility of ITNs and insecticide at all levels and this can he achieved through review of the delivery system of the programme. There is a need of more awareness creation to people for the use of ITNs and their treatment. There is a need to have research for differential prices. The people should be mobilised for improvement of their poor environmental sanitation around their living areas and also to conduct advocacy to institutional leaders for improvement of the working places. The efforts for mobilisation of people to seek medical care early should be continued and appropriate medical care for malaria patients in health facility should be maintained. There is a need to adopt Sector Wide Approach in the programme and rnulti-sectoral collaboration for