Title: Methods of ITN distribution
Course: Communicable Diseases Part 1 - Ethiopia (Full)

Methods of ITN distribution

There are two main methods of supplying nets to the community and maintaining high coverage. One is mass distribution, which is termed catch-up distribution of nets. This is a method used to achieve coverage of the entire community, or of target groups, as quickly as possible. The other method is termed keep-up distribution of nets. This is a method employed to maintain the coverage achieved by mass distribution by replacing nets as needed and providing nets for newcomers and newborns in a community.

There are a number of advantages of distributing ITNs through the Health Extension Programme under your supervision:

- ITN distribution is integrated into the existing health system, instead of relying on special campaigns.
- All malaria-risk villages of 5,000 people should have at least two Health Extension Workers or Practitioners like yourself deployed close to the community. Your knowledge of the customs and culture of your community will be very helpful in increasing the acceptability and use of ITNs. You will also have first hand information about family size and the number of sleeping sites in each household, which determines the number of nets needed in your community (as in Table 11.1).
- Through your activities, ITNs can quickly be replaced or supplied as needed, ensuring continuous access to ITNs (summarised in Box 11.1). This should reduce the proportion of people in your community remaining uncovered due to damage or loss of nets, and ensure that additional nets are available for pregnant mothers and newborn babies.
- Planning the requirement of ITNs for continuous replacement and additional distribution can be based on precise information collected by community-based health workers such as yourself, so it is more likely to reflect ITN requirements accurately.

Box 11.1 Health Extension Programme activities in ITN distribution in malarious villages

You are expected to perform the following activities in order to effectively and efficiently undertake ITN distribution in your village:

1. Determine the number of households in your village.
2. Determine the average family size in your village (the total number of people in your village divided by the total number of households in the village).
3. Prepare a record of the number of people in each family and if possible the number of sleeping sites in each household.
4. Submit your plan, including the above data, to the District Health Office.
5. Discuss with community leaders and elders, and with community health workers, how to distribute the nets as quickly as possible, and involve them in distribution of the nets.
6. Transport the required number of nets from the District Health Office to the health post.
7. Arrange temporary storage of the ITNs.
8. Train community health workers on procedures of ITN distribution and the key messages about proper and consistent use, which they should communicate to the households during ITN distribution.
9. Always give priority to children under five years old and pregnant women, when there are not enough nets to cover the whole population. Pass the message to the households about prioritising the nets to protect their young children.
10. Distribute nets as soon as they arrive at the health post.
11. Consider distributing the nets through house-to-house visits, as this will be the best way to assist the households with hanging the nets and teaching them the proper use of the nets.
12. Ask households to remove badly damaged nets, tear them down to be used as window screens or put them under the mattress or mat to kill other pests, like bedbugs. Never allow households to keep using damaged old nets while keeping new nets unused.
13. Always unpack nets before handing them to beneficiaries.
14. Convince households to repair damaged nets promptly, to extend their useful life.

The following are different ITN distribution mechanisms that you have to know to do your job effectively. Remember that appropriate mechanisms of nets distribution and replacement should be discussed with your supervisors at the health centre and District Health Office. The choice of distribution and replacement methods depend on the availability of nets at Regional and District levels.