Long-lasting, insecticide-treated nets (LLIN) scale-up and hang-up programme

International Federation of Red Cross and Red Crescent Societies, Geneva, 2009 Copies and translations of all or part of this document may be made for non-commercial use, providing the source is acknowledged. The International Federation would appreciate receiving details of its use. Cover photo: © M. Hallahan/Sumitomo Chemical-Olyset Net All inside photos: International Federation

2009 International Federation of Red Cross and Red Crescent Societies P.O. Box 372 CH-1211 Geneva 19 Switzerland Telephone: +41 22 730 4222 Telefax: +41 22 733 0395 E-mail: [email protected] Web site: www.ifrc.org

Long-lasting, insecticide-treated nets (LLIN) scale-up and hang-up programme

Contents Foreword

5

Acknowledgements

6

Abbreviations and acronyms

7

Executive summary

8

Introduction 1 What is this module for? 2 Who is this module for? 3 Why was this module developed? 4 What does this module include?

11 11 11 11 11

Global epidemiology of malaria

13

Prevention of malaria: distribution of LLINs 1 Introduction 2 The Roll Back Malaria Initiative 3 WHO and the use of LLINs 4 Strategies for distributing LLINs 5 Monitoring LLIN distribution programmes 6 Challenges of LLIN distribution programmes

14 14 14 14 16 17 18

Red Cross Red Crescent involvement in LLIN distribution programmes 1 National Society involvement in LLIN distribution to date 2 The Millennium Development Goals and Strategy 2010 3 International Federation involvement in global malaria policy and collaboration with others 4 The Red Cross Red Crescent’s role in reaching the Roll Back Malaria 2010 targets

19 19 19 20 20

Integrated approaches and links to other Red Cross Red Crescent health programmes 1 CBHFA 2 Gender and child protection

22 22 22

The International Federation’s future involvement in malaria

23

Practical programming steps

23

Step 1: Initial preparatory planning 1. Preparing a plan of action: coordination with the ministry of health and other partners 2. Memorandum of Understanding between the National Society and ministry of health 3. Information mapping and assessment for National Society plan of action

24 24 26 26

LLIN scale-up and hang-up programme

2

International Federation of Red Cross and Red Crescent Societies

4. 5.

National Society activity plan and chronogram Setting National Society specific objectives and goals through which to measure activities

27 28

Step 2: Planning for distribution activities at district level 1. Information to be gathered at district level 2. Planning activities with the ministry of health 2.1 Estimating the population of target groups and LLIN needs 2.2 District mapping and placing of distribution posts 3. Distribution posts (fixed and advanced) 3.1 Criteria for selecting fixed and advanced posts 3.2 Characteristics of a well-functioning post 3.3 Layout of a fixed post 3.4 Suggested areas at the post 3.5 Composition of the team at a post 3.6 Volunteer roles 3.7 Other issues 4. Planning for volunteer management 5. Planning for social mobilization 6. Planning for supervision 7. Planning for monitoring and evaluation

30 30 31 31 32 33 33 33 34 34 34 35 36 36 36 37 37

Step 3: Logistics (national, district and branch level) 1. Preparation for arrival of LLINs 2. Storage of LLINS 3. Clearance of LLINs at the port 4. Transportation of LLINs to district and distribution sites 5. Management of LLIN supply chain

38 38 38 39 39 39

Step 4: Budgets and financial reporting

41

Step 5: Training

43

Step 6: Planning for behaviour change communication, social mobilization and advocacy 1. Definitions 2. Behaviour change communication 3. Social mobilization 3.1 Developing a social mobilization plan 3.2 Social mobilization and behaviour change communication activities for volunteers 3.3 Preparing and distributing materials 3.4 Budgeting for social mobilization activities 4. Advocacy

46 46 46 46 47 48 49 49 49

Step 7: Child protection 1. Introduction 2. Why children need protection 3. Violence against children 4. Sexual abuse and exploitation

51 51 51 52 52

Guide / Contents //

5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Physical abuse Family violence Emotional abuse Neglect Impact of abuse How and why abuse happens Laws to protect children Reporting child protection concerns Protective factors Conclusion

3

53 53 53 53 53 54 54 55 55 55

Step 8: Hang-up activities

56

Step 9: Monitoring of activities See Malaria Assessment module

59

Step 10: Evaluation of activities See Malaria Assessment module

59

Appendices 1. Global Malaria Action Plan. Roll Back Malaria 2. HIV and malaria. International Federation of Red Cross and Red Crescent Societies 3. Malaria fact sheet

62 63 75 77

Practical programming step 1 4. Example of plan of action for social mobilization, integrated measles malaria programme 5. Example of Memorandum of Understanding 6. Example of chronogram for a mass LLIN distribution programme 7. Example of logical framework for a mass LLIN distribution programme

79 79 83 87 89

Practical programming step 2 8. Example of a district micro-planning template for a follow-up measles campaign 9. Key considerations for district level micro-planning for nets, examples of waybill, stock book and distribution log 10. Example of macroquantification: requirement for LLINs 11. Site set up PowerPoint presentation 12. Example of instructions for the proper marking of mothers’ and children’s fingers during a campaign

92 92

100

Practical programming step 3 13. Example of spreadsheet for estimating storage requirements 14. Selection of customs clearance agent: flowchart and notes 15. Selection of transport operators: flowchart and notes 16. Example of conveyor training agenda 17. Selection of warehousing facilities: flowchart and notes

101 101 102 104 106 107

93 96 97

LLIN scale-up and hang-up programme

4

International Federation of Red Cross and Red Crescent Societies

Practical programming step 4 18. Example of a budget template

109 109

Practical programming step 5 19. Example of training manual for supervisors and volunteers (extracts) 20. Supervisor job aids 21. Volunteer job support 22. Sample data collection form for household visit by volunteers 23. Sample data collection form for supervisors 24. Sample data collection form for semi-literate volunteers 25. Example of an integrated vaccination card

115 115 124 127 131 132 133 134

Practical programming step 6 26. Key targets for social mobilization

135 135

Practical programming step 7 27. Child protection. All children deserve to be safe 28. A training guide on child protection 29. Reporting form for disclosures of violence against children

136 136 137 140

Practical programming step 8 30. Hang-up data collection summary form for volunteers 31. Hang-up data collection form for supervisors

141 141 142

Guide / Foreword //

5

Foreword

The burden of malaria Malaria is a disease that affects between 300 and 500 million people each year. The disease is endemic to 109 countries in Africa, Asia, Latin America, the Middle East and the South Pacific, although 90 per cent of cases are in Africa. An estimated 3,000 children die every day from malaria. Those under five years of age and pregnant women are most vulnerable. Malaria also contributes to anaemia in children, undermining their growth and development. It is a primary cause of poverty, slowing economic growth. For this reason, given the burden of malaria on the entire population, the Roll Back Malaria partnership (RBM) has endorsed a universal coverage policy for ensuring access to prevention and treatment for all populations at risk. Millennium Development Goal (MDG) 6 refers directly to malaria. The target is, by 2015, to have halted and begun to reverse the incidence of malaria and other major diseases. Malaria also affects other MDGs: reduction of poverty, reduction of child mortality and improvement in maternal health. Malaria is the concern of everyone. The International Federation of Red Cross and Red Crescent Societies is a member of the RBM partnership and works closely with partners such as the World Health Organization, UNICEF, Centers for Disease Control and Prevention, USAID, Population Services International, Malaria No More and many others.

A preventable disease Malaria is preventable. There is growing scientific evidence that mass distribution campaigns to scale-up coverage of the population at risk rapidly with long-lasting insecticide-treated nets (LLINs) are an effective method for moving towards the Roll Back Malaria 2010 targets and MDGs. There is also evidence of the effectiveness of volunteer actions for ensuring distributed LLINs are hung properly and being used. The International Federation works to support National Societies to find funding to procure and distribute, free of charge, LLINs during large-scale integrated programmes, such as measles vaccination. In these distribution campaigns, our volunteers play a significant role in educating the community about how to prevent malaria. In follow-up “hang-up” and “keep-up” campaigns, volunteers are a valuable resource, with knowledge of their own community and how best to ensure messages are received and understood.

Malaria toolkit This set of publications is the latest in the International Federation’s fight against malaria. For the first time, it puts together in one package training guides for facilitators, supervisors and volunteers, documentation and examples of good practice. It is aimed broadly at anyone in National Societies around the world who wants to ensure that the battle to prevent and control malaria has behind it a policy, a set of tactics and techniques and useful example documents that will be effective in, and modified for, their own culture and environment. I am sure that it will be a useful tool in malaria prevention programmes everywhere.

Bekele Geleta Secretary General

LLIN scale-up and hang-up programme

6

International Federation of Red Cross and Red Crescent Societies

Acknowledgements Many thanks to all those who contributed to this module including Red Cross Red Crescent National Societies, delegates and secretariat staff. A number of National Societies have kindly given their consent to include the tools they have developed during activities for the mass distribution of LLINs.

Guide / Abbreviations and acronyms //

7

Abbreviations and acronyms A number of abbreviations and acronyms may be used in this module and the appendices. Whilst all efforts have been made to use the full forms and to avoid jargon, it is sometimes necessary to use the shortened form for the sake of brevity. This glossary provides a list of the most commonly used abbreviations and acronyms together with their full forms. ACT

Artemisinin-based combination therapies

ARCHI 2010

African Red Cross Red Crescent Health Initiative 2010

BCC

Behaviour change communication

CBHFA

Community-based health and first aid in action

CBO

Community-based organization

CCM

Country Coordinating Mechanism

DALY

Disability Adjusted Life Years

DPT

Diphtheria, Pertussis, Tetanus vaccine

EPI

Expanded Programme on Immunizations

EU

European Union

FedNet

FedNet web site (http://fednet.ifrc.org)

GAVI

Global Alliance for Vaccines and Immunization

GFATM

Global Fund to fight AIDS, Tuberculosis and Malaria

Global Fund

(as above)

HIV

Human immunodeficiency virus

IEC

Information, education and communication

International Federation International Federation of Red Cross and Red Crescent Societies IPT

Intermittent Preventive Treatment

IRS

Indoor Residual Spraying

ITN

Insecticide-treated net

LGA

Local government authority

LLIN

Long-lasting, insecticide-treated net

MoH

Ministry of health

NGO

Non-governmental organization

NID

National Immunization Days

NMCP

National Malaria Control Programme

NS

National Society

RBM

Roll Back Malaria

SIA

Supplementary Immunization Activities

STI

Sexually transmitted infection

USAID

United States Agency for International Development

UNICEF

The United Nations Children’s Fund

VCA

Vulnerability and capacity assessment

WHO

World Health Organization

LLIN scale-up and hang-up programme

8

International Federation of Red Cross and Red Crescent Societies

Executive summary This guide is designed for all Red Cross Red Crescent National Societies who are planning longlasting, insecticide-treated net (LLIN) distribution programmes for the first time, as well as for those who wish to strengthen their existing programmes. It is relevant for National Societies who wish to distribute LLINs at regional or district level. The module is aimed at National Society staff working at headquarters or branch level. It will enable them to undertake detailed planning of LLIN distribution programmes on a step-by-step basis, for which it includes a number of relevant tools. This module has drawn upon the combined global experiences of National Societies and the International Federation of Red Cross and Red Crescent Societies. The introduction sets the scene with an overview of the global epidemiology of malaria, as well as the interventions for malaria control as recommended by the WHO’s Global Malaria Programme, including LLIN distribution. The differences between conventionally treated nets and LLINs, and why LLINs are so much more effective at preventing the spread of malaria are shown. The module outlines strategies for the distribution of LLINs. This includes linking distribution to vaccination programmes and other health interventions as a proven way of increasing coverage and reducing time and costs, as well as the stand-alone distribution of nets and distribution through routine health services. Some of the common challenges of organizing distribution programmes are covered, including the fact that recipients fail to hang up the nets properly. In the past, not enough attention has been paid to designing and implementing strategies to ensure high net hanging and usage rates are achieved and sustained The historical involvement of National Societies in LLIN distribution is outlined, particularly for National Societies in Africa. Details are included on the role of the Red Cross Red Crescent and suggested tasks for National Society staff and volunteers in distribution programmes. It is also important that distribution programmes are integrated with other health programmes (where they exist), including Community-based health and first aid in action programmes (CBHFA). This module contains practical programming steps, which are useful as a guide for the mass distribution of LLINs. Where relevant, tools and specific examples of programming from different National Societies have been included for each of the steps. There is also information on the problems commonly encountered at each step. Step 1 provides guidance for the initial preparatory planning stage including coordination with the ministry of health and other partners and the preparation of the National Society’s own plan of action. An example of a National Society activity plan is included with the key elements. The setting of specific objectives and goals is touched upon, and an example of a logical framework tool used by the Malawi Red Cross Society is provided. Step 2 provides guidance for LLIN distribution programmes at district level. Key points are suggested for the implementation of activities. Suggestions are also given for the type of information which needs to be gathered for planning to take place. The potential role of a volunteer in the distribution and hang-up activities is outlined. The importance of planning for managing volunteers, social mobilization, supervision, and programme monitoring and evaluation is also covered. Step 3 provides guidance on the logistics for the distribution of LLINs including the storage, transportation and distribution of LLINs in country. Step 4 contains detailed budgets and financial reporting for each of the programme steps. Step 5 takes the reader through the process of preparation for training supervisors and volunteers, and includes specific suggestions of tasks for volunteers before, during and after the distribution.

Guide / Executive summary

9

Step 6 discusses behaviour change communication, social mobilization and advocacy, each concept being clearly defined. Detailed guidance is given on developing a social mobilization plan and implementing the activities. Step 7 is a short section on the importance of child protection with key messages on how to prevent harm to children during the implementation of Red Cross Red Crescent malaria activities. Step 8 provides detailed guidance on how to plan for hang-up activities and the key messages that need to be used. The correct hanging and usage of LLINs is critical to ensuring prevention of malaria. Step 9 Monitoring: See Malaria assessment module Step 10 Evaluation: See Malaria assessment module

Guide / Introduction //

11

Introduction 1. What is this module for? Red Cross Red Crescent National Societies have actively participated in the global effort to combat malaria, in particular in the mass distribution and use of LLINs. The role of African National Societies and the importance of their contributions to the success of campaigns have been increasingly recognized after the first involvement of the Ghana Red Cross Society in 2002. As efforts are increased, National Societies will benefit from developing their own capacity to deliver and support such programmes. This module is designed to help National Societies undertake detailed planning for such programmes on a step-by-step basis, drawing on the rich experience of the Red Cross Red Crescent to date.

2. Who is this module for? This module is aimed at National Society staff working at headquarters, chapter or branch level, who are planning LLIN distributions for the first time, and also for those who wish to strengthen existing distribution programmes.

3. Why was this module developed? National Societies in malaria-endemic countries have a wealth of experience in implementing activities for the mass distribution of LLINs. There is, however, to date no single document which draws all this experience together. This module has been produced in response to a perceived need for such a document and draws on the combined experiences of National Societies. It aims to provide National Societies with the necessary tools to enable them to plan and implement LLIN distribution programmes.

4. What does this module include? This module includes an introductory chapter with an overview of the global epidemiology of malaria including some of the factors exacerbating the fight against malaria. This is followed by the main strategies for effective malaria control, in particular WHO’s recommendations for the targeting of vulnerable populations and use of LLINs. Everyone is at risk of malaria in malariaendemic countries, but children under five years and pregnant women are the most vulnerable and should be a priority target group. Mass distribution of LLINs can be designed as stand-alone distributions, or can be integrated with the delivery of other health interventions, such as vaccination campaigns and child health or nutrition activities (such as vitamin A supplements and de-worming treatment). LLINs are also commonly distributed through National Society home-based care programmes. The module outlines the types of activities that are undertaken by many National Societies and it also describes some of the common challenges that programme implementers may face. Finally, detailed guidance is given on each of the steps involved in the process of planning and implementing a programme for the mass distribution of LLINs, including ensuring their use through hang-up and keep-up campaigns. The steps include guidance on: ■ developing a programme proposal ■ budget ■ social mobilization activities and methods ■ storage, transport and distribution of LLINs ■ identifying and training volunteers to take part ■ pre-distribution activities ■ hang-up and the start of keep-up activities

LLIN scale-up and hang-up programme

12

International Federation of Red Cross and Red Crescent Societies

The CD that accompanies the malaria toolkit provides examples of education, communication, logistics, monitoring and reporting forms. The module also includes short case studies that are used to illustrate examples of malaria activities undertaken by different National Societies. This module is not intended to serve as a prescriptive guide for National Societies, but rather provides a set of tools that National Societies can adapt for use in their own specific country context. The success of any LLIN distribution campaign often depends on a number of factors, including the capacity of the country’s ministry of health and other partners, as well as the capacity of National Societies. Early and detailed planning is crucial to success

Guide / Global epidemiology of malaria //

13

Global epidemiology of malaria There were an estimated 247 million malaria cases among 3.3 billion people at risk in 2006, causing nearly a million deaths, mostly of children under 5 years. A total of 109 countries were endemic for malaria in 2008, 45 within the World Health Organization (WHO) Africa region.1 It is endemic in the poorest countries of the world. Those most affected include pregnant women and children under five years of age with the highest mortality occurring at nine months of age. Others who are vulnerable to malaria are people living with HIV, refugees, people who are displaced due to conflict and migrant labourers.2 During the past two decades, morbidity and mortality from malaria have been increasing due to the growing resistance to drugs and insecticides, increasing poverty, poor infrastructure of health systems, climate change and natural disasters. Malaria is caused by a parasite that is transmitted from infected to uninfected people through mosquito bites. The mosquito that transmits the malaria parasite is most active between sunset and sunrise. In malaria-endemic areas, the annual economic growth rate is impeded and those who are very poor and marginalized are most affected as they have limited access to health care. In some countries there is a high prevalence of malaria all year round, while in others, infection rates change according to the season (dry, rainy). Malaria control priorities will depend on the malaria transmission factors in any given country. For more information on global malaria data, please see the Malaria Atlas Project (MAP) at www.map.ox.ac.uk/index.htm.

1 World Health Organization (WHO), World Malaria Report 2008. Available from: apps.who.int/malaria/wmr208/malaria2008.pdf. 2 WHO, Global Malaria Programme. See apps.who.int/malaria.

LLIN scale-up and hang-up programme

14

International Federation of Red Cross and Red Crescent Societies

Prevention of malaria: distribution of LLINs 1. Introduction Malaria is both preventable and treatable, and a combination of treatment and preventive measures can be used to control it. WHO’s Global Malaria Programme promotes the following three primary interventions for effective malaria control:3 1. diagnosis of malaria cases and treatment with effective medicines (in particular treatment with artemisinin-based combination therapies (ACT), and intermittent preventive treatment in pregnancy and in infants) 2. distribution of LLINs to achieve universal coverage and usage by all populations at risk of malaria 3. indoor residual spraying to reduce and eliminate malaria transmission by vector mosquitoes The efficacy of any of the above strategies will depend on the epidemiology of malaria in each country. Prior to beginning a LLIN distribution programme in a country, Red Cross Red Crescent National Societies should have discussions with the National Malaria Control Programme to determine how the needs of a population are best met for malaria prevention and control.

2. The Roll Back Malaria Partnership The Roll Back Malaria (RBM) partnership coordinates all those working globally in malaria. It has a wide range of partners including national governments in malaria-endemic countries, donors, non-governmental organizations, community-based organizations, and research and academic institutions. The Roll Back Malaria secretariat is based in Geneva with regional and country offices to support countries to increase their malaria interventions. For maximum effect, RBM encourages countries to subscribe to a country-specific strategy and a national coordinating mechanism, known as the “three ones”, that is, one operational plan, one coordinating structure, and one monitoring and evaluation programme. The Roll Back Malaria partnership has a number of working groups including the Harmonization Working Group and the Alliance for Malaria Prevention, concerned with the rapid global scaleup and use of mosquito nets. For more information on the Roll Back Malaria partnership, please see www.rollbackmalaria.org.

3. WHO and the use of LLINs Mosquitoes that transmit malaria are most active from dusk to dawn. LLINs, if properly used and maintained, can act as a physical barrier to mosquitoes and provide protection against malaria. LLINs are treated with an insecticide that is effective for three to five years or twenty washes. This combination of an insecticide barrier and a physical barrier (the net itself) makes LLINs much more effective than non-treated nets. The insecticide has a repellent effect on mosquitoes and most commonly kills them or has a knock-down effect so that the malaria parasite can no longer be transmitted even to those not covered by mosquito nets. When used correctly, LLINs have been shown to reduce malaria cases by approximately 50 per cent, effectively reducing all causes of child mortality by 20 per cent.4

3 WHO, Global Malaria Programme brochure 4 Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD000363. DOI: 10.1002/14651858.CD000363.pub2.

Guide / Prevention of malaria: distribution of LLINs //

15

When community coverage with LLINs is high, protection is given to those sleeping under the mosquito net, as well as to those in the same house and those living nearby.5 The Roll Back Malaria partnership promotes rapid and sustained scale-up and use of LLINs in order to reduce malaria morbidity and mortality. This is one of the many initiatives that Roll Back Malaria supports within the framework of malaria prevention and control. Insecticide-treated nets (ITNs) that need to be retreated with insecticide at home or in the community (once or twice a year or after every three washes) were in common use. LLINs are a relatively new and improved technology. They are designed to be stronger and to last longer, and importantly, they do not need to be treated or retreated on a regular basis. The insecticide is formulated and applied in a way that precludes the need for the insecticide to be replenished often. For more information, please see www.who.int/malaria.

Definitions of types of mosquito nets An insecticide-treated net (ITN) is a mosquito net that has been treated by dipping in a WHO-recommended insecticide. To ensure its continued insecticidal effect, the net needs to be retreated after three washes, or at least once a year, preferably before the arrival of the rainy season. A long-lasting, insecticide-treated net (LLIN) is a factory-treated net made with netting material that has insecticide incorporated within or bound around the fibres. The net must retain its biological effectiveness without retreatment for at least 20 washes under laboratory conditions and three years of recommended use under field conditions. LLINs remain effective for the expected lifespan of the net, with no need for retreatment at household or community level (three to five years). There are now numerous WHOPES6-approved LLINs and only these should be used. Today, almost all nets procured by national malaria control programmes are LLINs. Since 2002, a number of countries have been increasing their distribution of LLINs, which are free or are available at subsidized (reduced) prices. The Roll Back Malaria 2010 target is that at least 80 per cent of those at risk from malaria are protected through appropriate vector control, including LLINs.7 The WHO Global Malaria Programme is calling on national malaria control programmes and their partners involved in insecticide-treated net interventions to: ■ purchase only LLINs ■ distribute free or highly subsidized LLINs, either directly or through voucher or coupon schemes ■ achieve full LLIN coverage, including in high-transmission areas, by distributing LLINs through existing public health services ■ in due course, replace all mosquito nets with LLINs ■ develop and implement locally appropriate communication and advocacy strategies to promote effective use of LLINs ■ implement strategies to sustain high levels of LLIN coverage in parallel with strategies for achieving rapid scale-up

5 Malaria Roll Back Scale Up Report, Roll Back Malaria 6 WHO Pesticides Evaluation Scheme, which coordinates the testing and evaluation of pesticides for public health. For more information on WHOPES, please see www.who.int/whopes/en/. 7 Roll Back Malaria (2008), The Global Malaria Action Plan.

LLIN scale-up and hang-up programme

16

International Federation of Red Cross and Red Crescent Societies

4. Strategies for distributing LLINs Less than a decade ago, most mosquito nets were sold in markets, shops or health facilities, and were accessible only to those within a certain geographic catchment area and within a certain socio-economic group. In 2002, a pilot project was carried out in Ghana to see if nets could be distributed rapidly and effectively using the mass measles vaccination platform. Since this first link between measles campaigns and LLIN scale-up, the distribution of nets has been linked to other health activities, such as immunization campaigns (measles and polio) and child health days or weeks (vitamin A supplementation and treatment for intestinal worms are most common). Linking the distribution of nets to national immunization campaigns is a proven method of increasing coverage8, and a way of reducing time and costs. National or sub-national health campaigns can act as a useful platform for the distribution of LLINs, and this in turn can act as a good incentive for mothers to bring themselves or children for services. With the shift to targeting all populations at risk there has been a move away from LLIN distribution during integrated campaigns toward stand-alone distributions which target all households instead of only households with eligible children. In 2004, 100 per cent of nets were distributed during mass campaigns that were integrated with measles vaccination campaigns.9 In 2008, only 20 per cent of net distributions were integrated with measles campaigns. Ministries of health are increasingly using stand-alone distributions. In 2008, a number of countries carried out stand-alone distributions of LLINs. Countries are increasingly experimenting with a variety of platforms and methods in their efforts to reach the Roll Back Malaria 2010 targets of 80 per cent use of LLINs in all households. Vitamin A supplements and de-worming treatments for pre-school children are particularly important health interventions. Vitamin A supplements are key to improving infant and child survival, and play a specific role in strengthening the immune system and vision. Where diet is poor, WHO recommends biannual supplements of vitamin A for all children under five after the age of six months. Similarly, the de-worming of pre-school children helps to improve malnutrition and anaemia, improves appetite and decrease children’s vulnerability to infectious diseases. In many countries, vitamin A supplements, de-worming treatments and LLINs are a part of normal routine services, while other countries are still rolling out these initiatives. The mass distribution of LLINs can also be linked to home-based care programmes. Recent research has shown that there are links between HIV infection and malaria parasite load. In addition, links have also been established between increased ease of transmission of HIV and simultaneous infection with malaria, even in the period after malaria treatment has been completed.10 LLIN distribution has also been undertaken during emergencies. In emergency settings, the distribution of LLINs can be integrated with the distribution of items for shelter, water and sanitation, hygiene and food items. The timeframe for distribution is often shorter and many recommended activities are often dropped. This is partly because the planning is done for all items simultaneously, and partly because the elements of social mobilization may not be possible in certain emergency contexts. The International Federation of Red Cross and Red Crescent Societies currently distributes an average of 150,000 nets during emergencies each year.

8 Grabowsky, M et al. (2005) Distributing insecticide-treated bed nets during measles vaccination: a low-cost means of achieving high and equitable coverage, Bulletin of the World Health Organization, Volume 83 n.3, 195-201. Available from: www.who.int/bulletin/volumes/83/3/grabowsky0305abstract/en. 9 Ibid. 10 Malaria and HIV/AIDS interactions and implications. Conclusions of a technical consultation convened by WHO, 23-25 June 2004. Available from: www.who.int/hiv/pub/meetingreports/malaria_2004/en/index.html.

Guide / Prevention of malaria: distribution of LLINs //

17

In the last few years, WHO and UNICEF have made a joint commitment to support the development of more integrated programming for LLINs and immunization, and there are a number of different strategies for distributing LLINs.

Strategies for the distribution of LLINs LLINs may be distributed through a number of channels including: ■ through routine health services ■ through enhanced routine health services (concentrated promotion of child health interventions e.g. child health weeks) ■ integration with vaccination campaigns ■ integration with other child survival interventions ■ stand-alone distributions (these may be mass distribution of LLINs over a short period of time), effective where coverage is low and where they act as a boost to routine health services ■ integration with food distributions ■ through home-based care programmes ■ during emergencies It has been shown that integration and delivery of LLINs through a single system does not achieve the desired coverage targets, and a combination of models is necessary to reach all target groups. To date, more LLINs have been delivered through routine integrated systems than through specific campaigns. While nationwide delivery and sustained coverage levels through routine systems is the overall target, in some places where resources are limited, geographical areas are often selected for LLIN distribution, based on health and poverty indicators. To date, there are no standard methods used to monitor and evaluate the different models.

5. Monitoring LLIN distribution programmes Some of the key indicators currently used to monitor LLIN distribution programmes include:11 ■ percentage of households with at least one LLIN (and/or depending on the target population, percentage of households having a child under five or a pregnant women with at least one LLIN) ■ net usage ❏ percentage of children under five years who slept under a LLIN the previous night ❏ percentage of pregnant women who slept under a LLIN the previous night ■ cost-effectiveness of programmes ■ whether poverty affects access to nets Mosquito net utilization rates not only vary between different countries, but also within countries and depend on when surveys were actually undertaken. For example, utilization is often higher in the high-transmission or rainy season when mosquito bites are more common due to the higher density of mosquitoes. The monitoring of post-distribution activities is also important.

11 Roll Back Malaria web site: www.rollbackmalaria.org.

LLIN scale-up and hang-up programme

18

International Federation of Red Cross and Red Crescent Societies

6. Challenges of LLIN distribution programmes There are a number of challenges to ensure an effective mass LLIN distribution programme. Timing and logistics are major challenges. Measles immunizations, vitamin A supplements, deworming treatment and mosquito nets all need to be administered at different times in a child’s life. Measles immunizations are administered between 9 and 59 months, vitamin A between 6 and 59 months, polio between 0 and 59 months, and de-worming treatment between 12 and 59 months. This can present a logistical challenge as the target for net distribution is between 0 and 59 months. In some countries, there has been an unwillingness to include the 0–6 month target group, as they are not targeted for other interventions. The introduction of a campaign card to identify children by age and the interventions they are to receive has helped to resolve this problem at the point of service delivery. Regardless of whether LLINs are distributed during integrated or stand-alone activities, a key problem is ensuring proper use of the net once it has been distributed. Simply providing LLINs that are free of charge does not guarantee that the recipients will hang the net properly or that the target group will actually sleep under the net.12 Specific challenges include getting LLINs out of the packaging and making sure that beneficiaries hang them properly, use them every night and maintain use throughout the year. Another challenge in sustaining high coverage and use levels is that some members of the community are not registered with health centres. Post-campaign immunization and net coverage levels may drop because newborns, newly pregnant women and newcomers are often not systematically identified and referred to health centres for immunization and to collect their LLIN. Many people have limited or no access to health services because of distance, cost and poor quality of service. Moreover, in some countries, routine distribution of LLINs does not exist in all health facilities. Much work is still being carried out to study and evaluate the various distribution strategies to determine the most effective ways of distributing LLINs. Such strategies may include the best use of subsidies, the involvement of the commercial market, and a combination of public and private sector involvement. No single strategy will guarantee reaching the entire population, so a specified combination that best fits the needs of each country is usually required. The role of Red Cross Red Crescent volunteers in the mass distribution of LLINs is significantly greater when the Red Cross Red Crescent has already established an effective working relationship with the ministry of health and in-country partners.

12 Grabowsky M. et al. (2005) Integrating insecticide-treated nets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods, Tropical Medicine and International Health, 10(11): 1151–1160. Baume, C.A., Marin, M.C., Shafritz, L., Alilio, M., Somashekhar, S., Payes, R. (2005) Awareness, Ownership, and Use of mosquito nets in Nigeria, Senegal, Zambia, Ghana, and Ethiopia: Cross-country results from the 2004 NetMark surveys, Academy for Educational Development, Washington D.C. and NetMark Regional Office, South Africa. Wolken, et al. (2005) Final Report: Community-based Cross-sectional Coverage Survey One-month Post Campaign, Togo, International Federation of Red Cross and Red Crescent Societies.

Guide / Red Cross Red Crescent involvement in LLIN distribution programmes //

19

Red Cross Red Crescent involvement in LLIN distribution programmes 1. National Society involvement in LLIN distribution to date The International Federation of Red Cross and Red Crescent Societies first began actively supporting National Societies in the mass distribution of LLINs in 2002. Initial activities focused solely on the distribution of mosquito nets, but in 2004 this broadened to include hang-up and keep-up activities in an effort to improve and sustain high usage rates, especially following mass LLIN distribution campaigns. Efforts have also been made to promote the integration of malaria activities into ongoing CBHFA programmes. In some countries, nets have been distributed through the existing home-based care programme for people living with HIV. National Societies have taken part in mass campaigns initiated and led by their ministries of health. Since 2002, there has been a progressive increase in National Societies’ participation in distributing LLINs in mass campaigns. In the first campaign in which a National Society participated, 15,000 nets were distributed to one district in Ghana. This was followed by a subsequent campaign in Zambia where 75,000 LLINs were distributed in five districts. In both campaigns, the distribution of LLINs was linked to mass measles vaccinations. In 2004, the distribution of LLINs was scaled up country-wide in Togo, where the National Society was one of the implementing partners with a specific initial focus on social mobilization activities linked to the campaign and tasks at the distribution posts. Later keep-up activities were focused on post-distribution behaviour change communication messaging and included multi-year activities to ensure LLIN usage rates are maintained over time.13 Since 2002, National Societies have worked in partnership to distribute millions of LLINs worldwide. The International Red Cross and Red Crescent Movement has also made a significant contribution to international policies on LLIN distribution. The results of the LLIN distribution in Togo led WHO and UNICEF to change policy and recommend using the platform of immunization campaigns to rapidly scale up malaria prevention.14 Since the 2004 country-wide distribution in Togo, there was a rapid expansion of Red Cross Red Crescent involvement in malaria activities. Activities have included the distribution of LLINs, exchange of malaria expertise and expansion of technical support within the International Red Cross and Red Crescent Movement. Each mass distribution of LLINs by a National Society is different in scope. Mass distributions may be at country-wide level, sub-national level, at district level, during emergencies or targeted at home-based care programmes. This module can be used by National Societies as guidance for mass distributions of LLINs for different scales of distribution. The stages involved will be the same for both national and smaller-scale distributions.

2. The Millennium Development Goals and Strategy 2010 The eight Millennium Development Goals (MDGs) are in harmony with the four core areas of the International Federation’s Strategy 2010: 1. capacity-building of National Societies 2. social mobilization

13 International Federation (2006) The Red Cross and Red Crescent Malaria Keep Up Programme Concept Paper 14 Monclair M (2008) Scaling up malaria interventions - A new strategy to meet the MDG, Nordic School of Public Health

LLIN scale-up and hang-up programme

20

International Federation of Red Cross and Red Crescent Societies

3. partnerships 4. advocacy and community empowerment Both the MDGs and the Strategy focus on vulnerability. In particular, the sixth Millennium Development Goal focuses on the need to halt and begin to reduce the incidence of malaria and other major diseases by 2015. Specific indicators centre on the prevalence and death rates associated with malaria, and the proportion of the population in malaria-risk areas using effective malaria prevention and treatment measures. It is also important, when planning for malaria prevention, to take into consideration the third Millennium Development Goal: the promotion of gender equality and the empowerment of women.

3. International Federation involvement in global malaria policy and collaboration with others The International Federation has been actively working with UN agencies, government bodies and international NGOs to undertake LLIN distributions. Major partners include WHO, the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), European Union, United States Agency for International Development (USAID) and the Global Alliance for Vaccines and Immunization (GAVI). The International Federation has been working particularly closely with WHO and the Global Fund, and chairs the Alliance for Malaria Prevention, a sub-group of the Roll Back Malaria Partnership.

4. The Red Cross Red Crescent’s role in reaching the Roll Back Malaria 2010 targets The Roll Back Malaria Partnership’s targets are to ensure that by 2010: ■ 80 per cent of people at risk from malaria are protected with LLINs or indoor residual spraying ■ the malaria burden is reduced by 50 per cent compared with the year 2000 And to ensure that by 2015: ■ malaria morbidity and mortality are reduced by 75 per cent compared with the year 2005 ■ malaria-related Millennium Development Goals are achieved The Red Cross Red Crescent aims to contribute to these targets through its different activities. During the mass distribution of LLINs, the most effective role of the Red Cross Red Crescent is to undertake social mobilization activities, the distribution of LLINs and post-distribution activities such as hang-up and keep-up campaigns. These activities are undertaken both at community and household level, and the scope of activities will depend on the reach of volunteers and the budget available. The distribution of LLINs should not be undertaken without accompanying hang-up and keepup activities, as these activities have been shown to improve net usage by up to 25 per cent. Any National Society distribution of LLINs should be undertaken in full partnership with the ministry of health, which is responsible for tracking malaria activities at the country level. National Societies may be involved in two types of mass distribution of LLINs including: distribution as part of a larger campaign with the ministry of health and the National Society working together, either integrated with other health activities such as immunization, or standalone ■ the distribution of a smaller number of LLINs undertaken by the Red Cross Red Crescent only ■

Guide / Red Cross Red Crescent involvement in LLIN distribution programmes //

21

The ministry of health should take the lead in mass distributions, and assign and allocate tasks to the National Society, who should work in their traditional role as an auxiliary to government. The following are some of the tasks which National Society staff and volunteers may need to undertake during the distribution of LLINs.

LLIN distribution tasks for National Society staff and volunteers ■ ■ ■

■

planning for a campaign including activities (plan of action) and the budget logistics (including organizing the clearance of LLINs from the port of arrival, storage of LLINs, transportation and distribution of LLINs to beneficiaries) implementation of activities (at district and community level) ❏ encouraging beneficiaries to go to a distribution point to receive their LLIN ❏ health promotion on the transmission and prevention of malaria and other campaign interventions linked to child survival, house-to-house visits to promote hanging and keeping up LLINs ❏ setting up a site for the distribution of LLINs and being part of the distribution team (organizing beneficiaries at site, promotion of key messages, marking vaccination cards, marking caretakers and children with indelible ink, demonstrating LLIN use, issuing LLINs to target groups, registration and recording activities) ❏ supervision of the above activities training to undertake the above activities

The following is an example of some of the post distribution keep-up activities carried out by the Togolese Red Cross.

Togolese Red Cross keep-up activities ■ ■ ■

the promotion of early home treatment of fevers for children under five years of age referral of serious cases to local health centres the promotion, distribution and usage of LLINs

Activities to promote immunization were also carried out including the identification of newborns and new infants at household level, follow-up to ensure they complete their vaccination series, and the referral of pregnant women to prenatal facilities for intermittent preventive treatment of malaria and tetanus toxoid vaccinations.

LLIN scale-up and hang-up programme

22

International Federation of Red Cross and Red Crescent Societies

Integrated approaches and links to other Red Cross Red Crescent health programmes 1. Community-based health and first aid in action (CBHFA) It is essential that programmes for the mass distribution and use of LLINs be linked with National Society CBHFA programmes where they exist, as they often include malaria as a topic. CBHFA aims to develop both the skills of National Society volunteers and the capacity of branches to empower communities to address their health priorities. CBHFA programmes can provide National Society volunteers with a good knowledge of the Red Cross Red Crescent core competences, principles and values, as well as skills in basic first aid and injury prevention, and how to prevent common diseases in their own communities. It is important that volunteers can mobilize communities effectively to take part in collective action. If a mass distribution of LLINs is planned in an area where a CBHFA programme is being implemented, efforts should be made to incorporate CBHFA trained volunteers in the process, from pre-campaign planning to post-campaign hang-up activities.

2. Gender and child protection The International Federation aims to emphasize both gender and child protection when planning for the mass distribution of LLINs. It is envisaged that all Red Cross Red Crescent programmes should benefit men and women equally according to their different needs. Programmes should also have the input and equal participation of both, in line with the International Federation’s gender policy that was adopted in 1999. Gender refers to responsibilities, interests and capacities of both men and women, with their differing roles defining their needs.15 As pregnant women and children under five years of age are particularly vulnerable to malaria, a gender-sensitive approach is important. The International Federation is currently in the process of giving weight to child protection issues in much of its programming. Violence against children is a problem world-wide and has an impact on everyone. Children are more vulnerable than adults to abuse of power, which can take different forms including physical, sexual and emotional mistreatment. Practical programming step 7 of this module includes more details on child protection including guidelines about which actions to avoid when working with children to prevent abuse taking place.

15 Moser, C. (1993) Gender Planning and Development: Theory, Practice and Training, Routledge.

Guide / The International Federation’s future involvement in malaria //

23

The International Federation’s future involvement in malaria The International Federation would like to develop malaria programming with activities to: ■ ensure all mass LLIN distributions are followed with hang up and keep up activities ■ integrate with CBHFA programmes where they exist ■ assist National Societies to use FedNet for an outline of the history of Federation involvement in malaria activities ■ use FedNet to detail the experiences of different National Societies, and to share tools ■ carry out exchange visits ■ provide further technical support

Practical programming steps The ten steps which National Societies may use as a guide when undertaking the mass distribution of LLINs in a non-emergency context are as follows: Step 1 Initial preparatory planning Step 2 Planning for distribution activities at the district level Step 3 Logistics (national, district and branch level) Step 4 Budgets and financial reporting Step 5 Training Step 6 Planning for behaviour change communication, social mobilization and advocacy Step 7 Child protection Step 8 Hang-up activities Step 9 Monitoring of activities Step 10 Evaluation of activities Each of the ten steps includes a number of sub-steps, and may include some of the following components where relevant and available: ■ guidelines ■ notes on each sub-step ■ reference to relevant tools and examples (included in the Appendices) ■ some of the common problems experienced by National Societies

LLIN scale-up and hang-up programme

24

International Federation of Red Cross and Red Crescent Societies

Step 1

Initial preparatory planning Preparatory planning includes coordination with the ministry of health and other partners at the national, regional, provincial or district level. This can involve preparing a plan of action, as well as securing funding for the campaign.

1. Preparing a plan of action: coordination with the ministry of health and other partners In many countries, National Societies participate in coordination and management meetings for different health priorities. Coordinating groups include the Inter-Agency Coordinating Committee and the Country Coordinating Mechanism. National Societies should actively participate in the planning process for the mass distribution of LLINs to ensure that their volunteers are fully integrated from the outset. Where National Societies do not have an established relationship with the ministry of health, early and open participation is desirable for the National Society to ensure its presence. There should be only one national plan of action, which the National Society should be involved in developing through the coordinating structure. The strategy may include the sole distribution of LLINs, or be integrated with other health activities such as measles and polio immunization, vitamin A supplementation and/or de-worming treatment. It is usual for the ministry of health to take the lead in preparing the plan of action with input from partners, of which a National Society might be one. The ministry of health should own and take the lead in overseeing the overall implementation of the plan. Partners at different levels of the distribution process (national, regional and district) should be identified, their strengths assessed and their contribution clarified. Different partners will undertake different activities according to their strengths and capacity. Partners may include departments within the ministry of health, UNICEF, WHO, international NGOs, local NGOs, religious groups and the National Society. The specific role of a National Society in this distribution process should be clearly set out. The primary role of the National Society during mass distribution campaigns is social mobilization. As such, the National Society should actively participate in the communications sub-committee to harmonize their messages and volunteer support with those of the ministry of health and other partners. The National Society should also participate in other relevant sub-committees, such as those dealing with logistics and technical matters, depending on how its role is defined. Most importantly, the National Society should be present at the coordination meetings that take place with all partners to ensure that their role in the campaign is clear and that they are well integrated in the campaign’s planning and implementation process. Having clearly established its role in the distribution, the National Society should then develop its own plan of action and include the activities in which it will participate. For an example of an action plan, see appendix 4. It is also important that gender issues should be included at all stages of programme planning, implementation and evaluation. Mass LLIN distribution programmes should address women’s practical needs, improve their access to health services and information, and help them have more control over their own health. The efficacy of any of the malaria prevention strategies that are recommended by WHO will depend on the epidemiology of malaria in each country. Before a LLIN distribution is put into effect, the National Society should contact the National Malaria Control Programme to discuss how the needs of a population may be best met.

Guide / Practical programming steps //

25

Summary of plan for the mass distribution of LLINs For more information on what should be included in the national plan of action, please see the Alliance for Malaria Prevention Toolkit.16 The following is a summary of what should be included: ■ coordination structure and roles and responsibilities of all partners involved (including the National Society) ■ objectives of the distribution, target populations and geographic areas including: ❏ population data ❏ population estimates (especially children) ❏ most at-risk groups (infants 0–11 months, children 12–59 months, pregnant women, individuals in hard-to-reach areas, internally displaced persons, refugees and those involved in home-based care programmes) ❏ implementation plan and campaign strategy (including communication with advocacy and social mobilization, logistics, service delivery and data management, coordination and resource generation and follow-up) ❏ interventions to be included and method of delivery (net distribution strategy and any integration with other health activities such as immunization, vitamin A supplements and de-worming treatment) ❏ coverage and use targets ❏ timeline for target activities such as micro-planning, campaign preparation (development of supports and guides), implementation (training and supervision) ❏ budget estimates ❏ proposed methodology to monitor and evaluate the plan When developing the plan, it is important to estimate needs for the LLINs, equipment, personnel (including crowd control or delivering LLINs), forms for reporting, training materials and job support (instruction sheets for Red Cross Red Crescent volunteers). It is important that National Societies attend and contribute to all national planning and review meetings with the ministry of health and other partners, and that they work with the ministry of health from the start of the mass distribution. Where National Societies are undertaking standalone distributions of smaller numbers of nets, the most important link to the ministry of health may be at the regional or provincial level, rather than at the national level.

Common country coordination problems ■ ■ ■

■

lack of clarity on the roles of each partner involved in the distribution process a late announcement by the ministry of health about a mass distribution programme, leaving the National Society with little time for adequate planning and participation lack of clarity by a National Society regarding the extent of their volunteer network, leading the ministry of health and partners to assume that the entire project area is covered when, in reality, there are large gaps lack of participation of some partners leading to a breakdown of the partnership

16 Available from: www.aed.org/Publications/upload/LLIN_English.pdf.

LLIN scale-up and hang-up programme

26

International Federation of Red Cross and Red Crescent Societies

2. Memorandum of Understanding between the National Society and ministry of health Many National Societies have worked with their ministry of health in various roles for many years. These National Societies often have either formal or informal agreements with the ministry of health regarding the role and responsibilities of the National Society and its volunteers. It is useful in this case to have a formal Memorandum of Understanding between the National Society and the ministry of health before the start of the campaign to ensure that all roles and responsibilities are clear. See appendix 5 for an example of a Memorandum of Understanding.

Drawing up a Memorandum of Understanding When drawing up a Memorandum of Understanding between a National Society and the ministry of health, it may be useful to include information on the following subjects: ■ background information ■ duration of the campaign ■ purpose, project activity and objectives ■ terms of agreement and governing terms ■ responsibility and role of party A ■ responsibility and role of party B ■ services provided ■ financial management and budgets ■ evaluation and reporting ■ audit ■ signatures

3. Information mapping and assessment for National Society plan of action Much of the information that should be included in the National Society’s plan of action should be taken from the national plan of action. The type of information the National Society needs to gather for its plan of action will depend on its specific role during the campaign and will be related to its activities.

Information mapping and assessment Carry out a quick mapping of National Society branch capacity in the geographical regions selected by the ministry of health for the distribution. This will help to assess which branches can most successfully contribute to the national distribution programme and where strengthening of the branch will be necessary. A National Society branch capacity mapping might contain: ❏ number of volunteers ❏ number of supervisors ❏ distribution point locations ❏ involvement of volunteers and supervisors in health activities ❏ previous training and follow-up received for CBHFA, ARCHI, or community health ❏ transportation and facilities available at the branch ■ How do you know how many volunteers and supervisors will be needed for the campaign at the branch in question? ■ List the types of activities that volunteers might undertake during the campaign. Note: National Societies should collect information on the number of volunteers in the different branches and identify where there are gaps. The aim should be to fill those gaps.

Guide / Practical programming steps //

27

National Societies may experience some problems when gathering information and carrying out assessments. An inaccurate calculation of the actual number of LLINs needed may result in some distribution sites being left with insufficient nets and in disappointed communities when expectations have been raised. When calculating the number of LLINs required, be sure to check with NMCP regarding insecticide-treated nets policy. One method to calculate the number of LLINs needed for the population is as follows. This calculation will vary according to the NMCP LLIN policy.

How to calculate the number of LLIN nets Data to be gathered 1. Total population of country, region or health district (depending on project scope) 2. Target population: children under five years, pregnant women, people living with HIV 3. LLIN distribution strategy: decision on how many nets per target population to be provided Equation Target population multiplied by the number of target population per LLIN Example of how to calculate the number of LLIN nets The ministry of health distribution strategy is one net to each child under five years of age. 100,000 (under-five population) x 1 (number of target population per LLIN) based on a distribution strategy of one LLIN per under five. It is usual to add a10 per cent buffer for contingency. 100,000 nets required + 10 per cent (10,000) Total net need 110,000

4. National Society activity plan and chronogram Once the national plan for the LLIN distribution has been written by the ministry of health and its partners, it is usually then used to mobilize resources to carry out the campaign. National Societies will need to prepare their own plan of action based on the specific activities that they will be carrying out. Some of the data already included in the mass distribution plan of action should be included in the National Society activity plan, in addition to the National Society specific data collected above. National Societies may wish to seek funding from other National Societies, the International Federation or other donors outside the Red Cross Red Crescent. For example, UNICEF often funds communication activities and may provide support for volunteer activities. Suggestions for key elements to be included in the National Society plan of action are listed below. In some instances specific suggestions are included, for example, overall goal of the campaign and specific objectives.

Key elements of an activity plan for a mass distribution Introduction ■ Background information on National Society (including numbers and activities of existing volunteers and geographic spread, specific community health activities (including malaria) and coordination with other organizations). Overall goal of campaign ■ To decrease morbidity and mortality due to malaria (and other diseases where relevant) in children under the age of five or total population (depending on LLIN distribution strategy) by achieving a high percentage coverage and usage of LLINs.

LLIN scale-up and hang-up programme

28

International Federation of Red Cross and Red Crescent Societies

Specific objectives ■ Mobilize X number of volunteers to participate in X number of districts in order to carry out social mobilization and support activities. ■ Assist with mass distribution planning and implementation including promotion for hang-up of nets, with the aim of increasing coverage and net usage to 80 per cent. ■ Increase community awareness of how to hang up LLINs (with timeframe). ■ Improve community awareness of malaria prevention and control. ■ Mobilize existing volunteers for the campaign and recruit new ones where necessary. ■ Increase the general capacity of volunteers to support ministry of health and partner health programmes and increase the profile of the National Society country wide. Geographical areas of the campaign and National Society’s capacity ■ provinces or districts or National Society branches or villages National Society activities ■ participation in coordination meetings ■ social mobilization (before, during and after) ■ logistics (before, during and after) ■ monitoring and evaluation Campaign budget ■ details of the budget that supports the proposed activities (see step 4 on budgets and financial reporting)

Activity plans: common problems for National Societies ■ ■ ■

A substantial investment in terms of staff time and money must be made initially in order to gather the relevant information that is needed to develop a detailed and useful plan. If proposed objectives and activities are not clearly defined, this then causes problems when developing the budget. The scope of National Society activities is often underestimated due to a lack of understanding of the workload and capacity required to carry out the activities.

A chronogram can be defined as an activity plan with a timeframe included. Appendix 6 is an example of a chronogram for a mass LLIN distribution programme produced by the Nigerian Red Cross Society in 2008.

5. Setting National Society specific objectives and goals through which to measure activities The following table contains a list of the general and specific objectives that the Mali Red Cross used during a mass distribution.

Objectives 1. To increase the visibility and the effectiveness of the Mali Red Cross intervention through the establishment of a network of dynamic and adequately equipped and trained volunteers. 2. To increase the capacity of Mali Red Cross in financial, logistical and technical management of projects for the distribution of LLINs throughout the six regions of Mali. 3. To establish or strengthen collaboration between Mali Red Cross and its partners, particularly the Ministry of Health and Canadian Red Cross, for social mobilization and support of various activities concerned with the LLIN distribution project.

Guide / Practical programming steps //

29

Specific objectives: 1. Strengthen collaboration between Mali Red Cross and its partners. 2. Increase awareness and visibility of Mali Red Cross. 3. Strengthen the network of volunteers. 4. Improve the level of equipment and training of volunteers. 5. Improve means of communication at base level. 6. Increase social mobilization. 7. Ensure that 100 per cent of mothers of infants between 0-59 months receive LLINs. 8. Ensure the establishment of Red Cross committees in target zones. 9. Increase financial management capacity of the National Society. 10. Increase project management capacity of the National Society. 11. Retain a dynamic partnership between Mali Red Cross and Canadian Red Cross. It is also useful to prepare a logical framework for the mass distribution programme, which should include: ■ main activities ■ expected outputs ■ annual targets ■ indicators ■ estimated costs ■ the person responsible for each activity ■ implementing partners ■ means of verification ■ assumptions or assumed risks For further information on logical frameworks, please see appendix 7: Example of a logical framework for a mass LLIN distribution programme produced by the Malawi Red Cross Society in 2007.

LLIN scale-up and hang-up programme

30

International Federation of Red Cross and Red Crescent Societies

Step 2

Planning for distribution activities at district level This section of the module focuses on planning at district level for a campaign that includes the distribution of LLINs either integrated with other interventions or stand-alone. Detailed micro-planning at the district level, including the health facility and/or distribution point level, is essential in order to carry out the mass distribution of LLINs successfully. See appendix 8 for an example of a district micro-planning template. Gender should be taken into account during this planning stage to ensure the participation of female beneficiaries. This may include holding same-sex focus group discussions when facilitating planning and social mobilization, the recruitment of equal numbers of female and male volunteers where possible, and adequate representation of women during the planning of the activity.

1. Information to be gathered at district level The table below from the Liberian Red Cross Society lists the specific information that can be gathered at the district level for mass distribution of LLINs.

Categories of data

Specific data

District population

Total population, population of settlements, population of hard-to-reach areas, target population

Population of children under five years old Children’s schools

Children’s schools: ■ Nursery, primary, secondary, number of teachers Other places to find children: ■ Parks, religious centres, community centres, orphanages

List of market days

Daily markets, other regular markets

Distribution posts

Fixed permanent at health facility, fixed permanent at other sites, temporary post

Transport facilities

Bicycles, motor bikes, vehicles, engines

Estimated distance of the settlement to the nearest health facility or distribution point Hard-to-reach areas

Distance of hard-to-reach areas from a known facility. Assessment of the state of the roads.

District and other maps National Society volunteer network in area

Mapping the number and distribution of volunteers. Assessment of gaps in the number of volunteers and how many new ones need to be recruited for the mass distribution.

Guide / Practical programming steps //

31

2. Planning activities with the ministry of health National Societies should work closely with the ministry of health when planning distribution activities and should be well represented in the process at district level. Where possible, the National Society should forge close links with local district councils to help pave the way for a smooth distribution process. National Societies may find the campaign a useful opportunity to recruit new volunteers. The tasks listed below should be carried out in conjunction with the ministry of health.

2.1 Estimating the population of target groups and LLIN needs Calculations need to include: ■ estimating the population or target groups ■ estimating the needs for LLINs ■ estimating the number of distribution posts required ■ estimating the number of volunteers, coaches, supervisors and staff required The following is an example of how to estimate the population of target groups and the number of LLINs required for an integrated campaign

Estimating the population of target groups An integrated campaign will target specific age groups of children for each intervention. Each target population for the distribution of LLINs, measles vaccination and the distribution of vitamin A tablets and de-worming tablets will need to be calculated. When calculating the target population, if: ■ the total population of a district = 150,000 ■ the target group for LLINs is the 0–59 months age cohort, estimated to be 18 per cent of the total population ■ LLIN distribution strategy is one LLIN per child 0–59 months Then the total target population for LLINs is estimated to be: 150,000 x 18% = 27,000 Calculating the number of LLINs Use the calculation formula given above in step 1, section 3. Note: The calculation of LLIN requirements will depend on the strategy for LLIN distribution chosen, which is likely to be one net per beneficiary. A margin of error of 10 per cent is usually factored into the calculation. The following is an actual example from the Sierra Leone Red Cross Society of how they calculated LLIN requirements at district level.

Sierra Leone Red Cross Society: calculation of number of LLINs needed Data for the Kono Health District Total population = 348,951 0–59 months population = 59,322 LLIN needs with a distribution strategy of one LLIN per child aged 0–59 months 59,322 + 10% (5,932) = 65,254 LLINs See also appendices 9 and 10 for calculations on requirement for LLINs.

LLIN scale-up and hang-up programme

32

International Federation of Red Cross and Red Crescent Societies

Estimating the number of marker pens needed for the campaign It is important to estimate and order enough marker pens to be used in the campaign. Both mothers and children will be marked on a nail when they have received a LLIN. ■ A mother with one child would receive one LLIN. In this case, both the mother and the child would each receive a mark with the pen (making a total of two marks). ■ A mother with two children would receive two LLINs. In this case, the mother and the two children would each receive a mark with the pen (making a total of three marks) Manufacturers rate one indelible marker as being good for 500 marks. However, markers are often left with the caps off, they dry in the sun and are overused when marking a single finger. Experience has shown that one marker generally makes between 250 and 375 marks. The following calculation should be used when determining how many markers are needed and includes a margin of error or “loss”. Total number of LLINs divided by 125 plus a 3% buffer stock = total number of markers. For example: Total number of nets to be distributed = 2,236,532 divided by 125 = 17,892 3% of 17,892 = 537 Total number of markers required = 17,892 + 537 = 18,429

2.2 District mapping and placing of distribution posts It is necessary to decide where distribution posts should be set up in the district.

Drawing a district map to decide where to site distribution posts Each district will have a number of distribution posts depending on target population, terrain and other factors which have been taken into account in micro-planning. Steps to follow: ■ List all settlements (permanent and temporary) with the estimated target population. ■ List all schools (nursery, primary, junior, secondary and religious). ■ List all health facilities. ■ List all hard-to-reach places and communities. Draw the district map ■ Show settlements, schools, health facilities and hard-to-reach communities. ■ Show landmarks such as roads, rivers and other essential indicators. ■ Allocate distribution posts to the settlements taking into account target population, distance and terrain. ■ Mark clearly the catchment areas of each distribution post or team. ■ Give a code number to each distribution post or team. An implementation plan of distribution posts should then be made to indicate where and when the distribution team will be active. The plan should be displayed at a designated district health facility and a copy given to the distribution post or team supervisor.

Guide / Practical programming steps //

33

3. Distribution posts (fixed and advanced) Distribution posts may be fixed, advanced or mobile posts. Fixed distribution posts are located at permanent health facilities where immunizations and other health services are routinely provided. They may also be located in schools, community centres, religious centres and offices. These sites can also serve as depots for storing and distributing LLINs or vaccines to temporary fixed sites. The fixed distribution post may serve a population within a five kilometre radius. The fixed distribution post should be used in densely populated areas and should remain open for the duration of the campaign. The first few days are often the busiest, after which the flow of people tends to decrease. Well developed micro-plans reduce congestion and crowding at fixed posts by either (a) setting up multiple posts within the same site or (b) providing additional personnel to cope with the rush of beneficiaries. Advanced posts are in areas that have been identified by the district health teams. They are made known to the population before the start of the campaign. LLIN distribution may be carried out from these sites for the whole day. Schools, community centres and religious centres are examples of good places to house an advanced post. The advanced post may serve a population within a 10–20 kilometre radius. The number of advanced posts used during the distribution may depend on the budget available.

3.1 Criteria for selecting fixed and advanced posts A good post should be: ■ situated in an area that is easily accessible to the community and with adequate space for crowds of people ■ preferably in a building or under a veranda or a tree that offers good shade ■ located in a clean environment with a latrine and water supply nearby ■ safe for health worker and client

3.2 Characteristics of a well-functioning post Well-functioning posts should have: ■ a banner or poster for identification ■ an efficient flow system so that guardians and their children can walk through the post from entry to exit thus avoiding bottlenecks, overcrowding, confusion and long waiting times ■ adequate space for the distribution team, enabling them to work efficiently and safely ■ adequate crowd control ■ space available for mosquito net demonstration ■ enough health staff and volunteers for the post to function ■ sufficient distance between the permanent fixed post and any other routine activities See also an example of site set-up in appendix 11.

LLIN scale-up and hang-up programme

34

International Federation of Red Cross and Red Crescent Societies

3.3 Layout of a fixed post The following diagram shows the layout of a fixed post:

This is the area where people are organized into lines to enter the vaccination site

ENTRANCE (1-2 people: crowd control/organization)

Registration: Mothers come with children under five. Volunteers identify age of child and mother is given a card for each child with the appropriate interventions checked off.

Registration (1-2 people)

Vitamin A and mebendazole: Children will receive either intervention as necessary and the card marked to indicate this.

Administration of vitamin A and mebendazole (1-2 people)

Measles vaccination: Children whose cards are marked for measles will be vaccinated and the card marked to indicate this.

Measles vaccination (2 people)

Distribution of LLIN: Mothers will present cards for all children and will be given a LLIN for each card marked. LLINs will be given with social mobilization messages and package torn. Volunteer will mark cards and mark mother and children with indelible ink.

Distribution of LLINs (1-2 people) EXIT (1 person)

3.4 Suggested areas at the post The following areas at a post are suggested: ■ waiting area, preferably in the shade ■ screening and registration area (screening activities may include directing children to each intervention according to their age) ■ LLIN distribution and demonstration area ■ checkpoint or recording area (tallying area). This will depend on whether the tally will be done by each intervention and if the sheet is at each table, or whether the tally will be done according to the campaign card ■ area for administrative activities for other interventions

3.5 Composition of the team at a post The distribution post typically comprises the following team members: ■ team supervisor (who is likely to be a ministry of health staff member) ■ crowd control ■ person responsible for screening and/or registration ■ distributor of LLINs

Guide / Practical programming steps //

■

35

tally person (responsible for tracking the number of LLINs distributed and for marking fingernails)

The team supervisor’s tasks are to: ■ oversee the whole process ■ support all Red Cross Red Crescent volunteers and other workers at the distribution site ■ ensure the tally sheets have been completed for LLINs and other interventions ■ ensure stock management of LLINs and other supplies ■ report daily summary data to the next level of staff each evening after compilation The crowd controller’s tasks are to: ■ ensure beneficiaries wait in the allocated areas ■ ensure people flow through the post and bottlenecks are avoided ■ clear the site area of vendors or other non-beneficiaries to avoid risky situations The tasks of the person responsible for screening and/or registering during an integrated campaign are to: ■ welcome beneficiaries ■ verify that the child is within the target age group ■ fill out campaign cards correctly at the registration table to ensure that children receive all interventions for which they are eligible including receiving a LLIN ■ direct mothers to the table administering the first intervention ■ register LLIN beneficiaries for follow-up after distribution The LLIN distributor’s tasks are to: ■ tear the packaging to deter the resale of nets in the market ■ hand out the nets ■ make a tally of LLINs and when completed give to the post supervisor ■ mark the nails of mothers and children who receive nets (this may be decided in-country) See an example of instructions for marking fingernails in appendix 12. ■ ensure that a demonstration net is already correctly hung to show beneficiaries ■ show the beneficiary the demonstration net and explain that the net must be hung low enough to be tucked under a mat or mattress to prevent mosquitoes from entering During integrated campaigns, the following registration challenges should be allowed for within the plan: ■ a child has no card and the age is unknown ■ explaining to mothers that not all children will receive a net where the net distribution strategy is not one per child ■ how to mark the card if a child is not receiving a net

3.6 Volunteer roles It is very important to define the role of the Red Cross Red Crescent volunteer clearly during the distribution process. The following are some of the roles a volunteer may undertake when working at a post: Control the waiting crowd and keep order. This is very important for the safety of both health workers and beneficiaries, especially to prevent harm to small children. It is a good idea to start planning for crowd control before the distribution starts. Ensure a one way flow of people through the post where possible. Assist the ministry of health or other partners with getting the site set up and ready for the campaign. This may include moving furniture, removing waste, carrying supplies, etc. Promote key messages to people within the post area.

LLIN scale-up and hang-up programme

36

International Federation of Red Cross and Red Crescent Societies

Mark children’s integrated vaccination cards (when integrated with other interventions) and explain to the mother the importance of keeping the card safe. Please see appendix 25 for an example of an integrated vaccination card. Mark the guardian and child with indelible ink according to ministry of health instructions. Please see appendix 12 for an example of instructions for the proper marking of mothers and children during a campaign. Perform other tasks as requested by the ministry of health supervisor.

3.7 Other issues It is useful to provide Red Cross Red Crescent volunteers with t-shirts, bibs or caps with suitable slogans for the campaign. This also helps to improve the visibility of the National Society. During mass distribution of nets, the first days are always very busy, because people fear that they will not receive nets if they are too late. Stock at posts may run out, resulting from prepositioning of LLINs not matching site attendance of beneficiaries. In this case, the supervisor can authorize LLINs to be brought from sites with a surplus. The campaign card can be used as a voucher by the mother to return to the site to receive a net the next day. Close to the end of the campaign, there may be real ruptures in stock, meaning that there are no nets left in the district or region that can replenish stock.

Common problems ■ ■ ■ ■ ■ ■ ■ ■

■

unclear assignment of responsibilities inadequate social mobilization for the distribution inadequate or late distribution of supplies to post teams inadequate transport makes it difficult to move nets between storage sites long queues of people or poor flow of people through the post registering children or recording too much information on each child posts do not open early or late enough or during lunch hours to be accessible to working parents (especially in urban and peri urban areas) not enough nets distributed to the stock sites because of an initial miscalculation of nets and beneficiaries (net stocks can be moved between sites if approved by a supervisor) towards the end of the distribution, stocks of nets are low in the district or region and cannot be replenished

4. Planning for volunteer management It is important to plan accurately for the number of community health volunteers, including those belonging to the Red Cross Red Crescent, who need to be involved in the campaign at a national level. This requires counting existing volunteers and estimating requirement for new recruits. Planning the training of volunteers will depend on this. Recruitment and management are the two key issues for those involved in Red Cross Red Crescent volunteer management. For more information, please see the International Federation Guidelines on Volunteer Management.

5. Planning for social mobilization It is important to plan carefully for social mobilization and hold sensitization meetings at district level between National Society staff and the ministry of health’s district health management team, community leaders, community chiefs and any other partners involved.

Guide / Practical programming steps //

37

6. Planning for supervision For detailed information on planning for supervision, please see the International Federation’s guide to supervising community-based volunteers17.

7. Planning for monitoring and evaluation The tools for monitoring of distribution activities at the district level are available in appendices 20 to 22. Tools for evaluating distribution activities, including data recording formats and tally sheets are found in the Malaria assesment manual.

17 International Federation of Red Cross and Red Crescent Societies, Malaria toolkit, Supervision of communitybased volunteers (to be published Autumn 2009)

LLIN scale-up and hang-up programme

38

International Federation of Red Cross and Red Crescent Societies

Step 3

Logistics (national, district and branch levels) Planning for the storage, port clearance, transportation and distribution of LLINs should be undertaken in cooperation with the ministry of health and all stakeholders and partners. Some or all of the following steps can be followed when considering the logistics of warehousing, transporting and distributing LLINs during a mass campaign. Once the LLIN order has been placed, based on calculations of need, a number of elements should be considered: 1. Preparation for arrival of LLINs 2. Storage of LLINs (see appendix 13) 3. Clearance of LLINs at the port (see appendix 14) 4. Transportation of LLINs to districts and distribution sites (see appendices 15 to 17)

1. Preparation for arrival of LLINs ■

Apply for all customs duty exemptions to which National Societies are entitled Apply for an exemption for any customs duties charged on the import of LLINs. The application process should be started well in advance of placing an order for LLINs, as an exemption can often take up to six months to secure. At a summit on malaria, held in Abuja in 2000, many African governments pledged to waive customs duty on LLINs. An exemption must be obtained in writing from the government.

■

Apply for an exemption for valued added tax Most countries will also charge value added tax (VAT) on the shipment. The amount varies from country to country. A VAT exemption should be applied for at the start of the process. An exemption must be obtained in writing from the government.

2. Storage of LLINS ■

Determine direct or indirect delivery of LLINs Before selecting a storage location, the method of delivery must first be determined. There are three main delivery options: ❏ Direct delivery: Containers can be cleared at customs and then moved directly to an inland location. At this point, the LLINs can be offloaded into a warehouse or left in the containers. Negotiations will be required with the shipper in order to determine the costs of demurrage18 in the event that the containers are detained. ❏ Indirect delivery: The shipment is moved to a central warehouse, the containers are offloaded and the LLINs moved out at a later date in order to comply with distribution timelines. ❏ A combination of direct and indirect delivery: The containers are emptied at or near the port, loaded onto trucks and then moved inland to selected locations. There may be several inland locations or, alternatively, a regional storage plan may be adopted where regional warehouses are used as an interim option. In all of the above cases, the platform, timing, security and local infrastructure will determine the best method for the storage and movement of LLINs, once these have arrived in the country.

18 Demurrage is the cost charged for not emptying a container at the port within a determined period (normally within five working days, but which may be extended by negotiation). This daily fee per container, imposed by the port authority, can add up to a substantial amount if there are delays in clearing customs, a process in which the port authority is not involved.

Guide / Practical programming steps //

39

■

Identify suitable warehousing for LLINs at the port or airport, capital city or district levels Warehouses for LLINs should be of an adequate size. The volume of LLINs to be stored should be calculated (length by width by height) to determine the size of the warehouse required. Warehouses should be accessible, dry and secure.

■

Prepare warehouse and tracking documents Standard forms and documents can be found in the International Federation’s CD-ROM on logistics standards, which was published by the Logistics and resource mobilization department in September 2002.

3. Clearance of LLINs at the port ■

Hire a customs clearance agent for the entry of the LLINs into the country A customs clearance agent will smooth the process of the arrival of the LLINs into the country, and it is essential to hire one. The initial search for an agent should be based on the recommendations of ministry of health and other NGOs. Cost assessments and general quotations should be requested. The choice of an agent should be based on a transparent comparative bidding analysis. This process is explained in appendix 14, comprising a flowchart for acquiring a customs clearance agent, together with accompanying notes. This example is provided by the Sierra Leone Red Cross Society.

4. Transportation of LLINs to district and distribution sites The following steps may be followed when transporting LLINs: ■ develop a transportation plan ■ identify potential transport operators ■ conduct a transparent comparative bidding analysis to select a transport operator ■ prepare and sign the necessary contracts ■ train staff in transportation logistics (approximately two days) ■ transport LLINs from the central warehouse to district warehouses ■ transport LLINs from the district warehouse to the distribution sites

5. Management of LLIN supply chain The following is a list of steps for managing the supply chain for a LLIN mass distribution campaign.

Specific steps involved in the logistics process for a LLIN distribution campaign ■ ■ ■ ■ ■

■

■ ■ ■

Identify a customs clearance agent to help get the LLINs through customs. Process the duty-free entry of LLINs, including an exemption from any value added tax. Plan a logistics field trip to identify costs once micro-planning is complete. Coordinate logistics with other partners, for example the ministry of health and other stakeholders. Develop a transportation plan, including identifying potential transport operators. The selection should be based on a transparent comparative bidding analysis. Prepare and sign the necessary contracts. Identify suitable warehousing in the capital city to store the anticipated number of LLINs. The selection should be based on a transparent comparative bidding analysis. Prepare and sign the necessary contracts. Identify suitable warehousing in the districts. Adapt the relevant warehouse and tracking documents. Undertake logistics training for two days at central level.

LLIN scale-up and hang-up programme

40

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■ ■

Organize logistics training for warehouse staff and conveyors. When the micro-planning has been completed, develop a distribution plan. Transport LLINs from the central warehouse to district warehouses. Transport LLINs from district warehouse to distribution points. Finalize logistics data for the end of distribution final report.

The above list is based on the experiences of the Mali Red Cross and Sierra Leone Red Cross Society’s’ malaria programmes. The timescale, from start to finish, is approximately seven months.

Conveyors: overview of role Conveyors play a critically important role in the overall distribution of LLINs, overseeing the delivery of nets from the central warehouse to county and district storage facilities. By accompanying deliveries, conveyors facilitate prompt and efficient delivery to the correct destination. They also ensure that deliveries are received and signed for by the proper receiving authority.

Breakdown of duties and responsibilities ■

■ ■

■

assisting in overseeing the loading of LLINs ❏ identifying themselves to the logistics coordinator and driver ❏ counting the number of bales being loaded and ensuring they are secured ❏ signing the waybill accompanying the delivery and checking the load at all times assisting in overseeing the unloading of LLINs ❏ identifying themselves to the receiver ❏ counting the number of bales being unloaded ❏ ensuring the waybill is signed by the receiver and returned to the logistics coordinator acting as contact point for delivery ❏ communicating any problems directly to the logistics coordinator and/or the contact person at the destination

Familiarization with waybill ■ ■

Know where to write down quantities and where to sign. Know which copies to deliver and which to retain.

Overview of routes and per diem amounts ■ ■

Provide a copy of the dispatch plan and assigning routes. Ensure that conveyers sign the per diem rate agreement.

The following logistics tools are available in appendices 13 to 17. ■ Planning spread sheet ■ Storage requirements ■ Customs clearance agent (notes and flowchart) ■ Warehousing (notes and flowchart) ■ Transport (notes and flowchart)

Guide / Practical programming steps //

Step 4:

41

Budgets and financial reporting Appendix 18 provides a budget spreadsheet for calculating the costs involved in an integrated child survival campaign where LLINs are included. This is an example of a specific country need, and it may need adapting for other countries.

1. The budget headings provided may not include some lines that are needed in your activities. In this case, it is easy to add a line in the relevant budget section. There may also be lines or sections that you do not need, in which case you can either delete or hide the lines. 2. The full spreadsheet is provided on the accompanying CD. In this case, the spreadsheet contains formulas in the cells. It is recommended that you always check your formulas to reflect your specific requirements. There is a link between the main sheet and the summary sheet. 3. Always do the budget in your own local currency and then use OANDA rate of exchange (www.oanda.com) for conversion to the currency in which you intend to seek funding. Always write the date of the rate of exchange. 4. The spreadsheet is divided into the following sections a. b. c. d.

micro-planning and volunteer identification social mobilization communication logistics

At the end there is a possibility to add an administration fee and/or overheads as well as bank charges.

5. Once the main budget is finalized, you may use the same section to do the budget breakdown according to the chronogram. Always do a budget for one calendar year even though in some months nothing will be spent. 6. For your guidance take note of the following assumptions and recommendations as these may help you arrive at an efficient use of existing funds: a. A volunteer can distribute up to 100–120 nets per day (number will vary by country and distribution strategy). b. Use for fuel consumption the rule of thumb 14–17 litres of fuel per 100 kilometres or a maximum of 20 litres per 100 kilometres. c. For motorcycles, the consumption is 4.5 litres (approximately one gallon) per 80 kilometres. d. For training of volunteers, try to keep the number to no more than 25 per training. e. Each supervisor should be able to supervise up to 50 volunteers in their community: supervision is needed as follows: ❏ one visit during the pre-campaign ❏ supervision during the campaign ❏ one visit after the campaign f. Stationery package for volunteer training should not cost more than 1.5 US dollars and includes a folder, notebook, pen, pencil, sharpener and eraser (will vary by country). g. Bibs (dossards) are better than t-shirts and the cost per bib should not exceed 3 US dollars (will vary by country). h. It is recommended that all supervisors, trainers or coaches are trained together (or in two groups) in a centrally located area of the region or country.

LLIN scale-up and hang-up programme

42

International Federation of Red Cross and Red Crescent Societies

7. Always put together detailed terms of reference for all supervision visits, whether at headquarters, regional, district or local level. Assess the need and plan visits accordingly. Supervision should not be out of line with the planned activities. 8. To calculate the logistics budget, you will need information from the ministry of health or population census for the number of beneficiaries in each district, region or province. The number and location of distribution points is important to calculate the logistics budget fully. Transport is often arranged as follows: a. Producer (agent) will arrange for transport to port or to the country if it is landlocked. b. Upon arrival the most economical way (where possible) is to transport directly to the districts, otherwise a warehouse is needed for storage at central level. c. Tender is sought for transport from port to warehouse to district (or port to district if no central warehousing). d. Transportation from district warehouse to distribution points should be planned in collaboration with the district health management team. It is important to ensure that the following are in place before any activity is implemented: a. Memorandum of Understanding with the ministry of health b. Memorandum of Understanding with funding partner c. letter of exoneration for all taxes and duties on the import of the nets d. letter from the ministry of health requesting the nets and specifying the type, colour and size e. letter from the ministry of health requesting indelible markers (where required)

9. For warehouse space and transport, use the International Federation logistic guidelines for calculations. Bales will vary in size depending on manufacturer and size. The requirement for loaders and offloaders will depend on the size of the container or truck, but five to ten loaders should offload a 12-metre (40-foot) container in five hours. 10. Your budget should mirror the chronogram for all activities.

Guide / Practical programming steps //

Step 5:

43

Training Training must be undertaken for both supervisors and volunteers in preparation for the mass distribution of LLINs. See appendix 19 for an example of a manual designed for training supervisors and volunteers. The full text can be found on the accompanying CD. It is advantageous if the ministry of health can co-facilitate the training in order to add technical expertise, improve the links between the two partners, and expose and update ministry of health staff on the Red Cross Red Crescent’s hang-up and keep-up activities. Training for Red Cross Red Crescent supervisors and volunteers needs to be undertaken well in advance of the distribution, as it is likely that the National Society will be involved in a longer period of pre-campaign activities compared to ministry of health staff. The Red Cross Red Crescent training should incorporate messages which are specific to the organization, as well as information on the management of volunteers, and financial and narrative reporting.

Planning for training ■ ■ ■ ■

■

Develop a work plan for training, including a timeframe. Develop training materials for social mobilization and logistics. Establish criteria to select the supervisors and volunteers who will attend training (for example, good gender balance of training participants). Undertake training for supervisors including: ❏ the content of the volunteers’ training package ❏ adult learning techniques ❏ behaviour change communication ❏ data collection and synthesis ❏ how to train volunteers using this training package ❏ how to supervise volunteers ❏ financial management ❏ how to write reports Undertake training for volunteers including: ❏ principles and values of the International Red Cross and Red Crescent Movement ❏ what the Red Cross Red Crescent can contribute to a mass distribution of LLINs ❏ roles and responsibilities of Red Cross Red Crescent volunteers ❏ roles and responsibilities of all partners ❏ background information on the interventions included in the campaign and/or distribution ❏ key facts on malaria transmission and prevention ❏ social mobilization: addressing the what, why, who, how, and where to undertake it ❏ the importance of clear messaging ❏ site organization and tasks, registration, LLIN distribution, tallying and reporting ❏ child protection issues

The level and format of the training will depend on the existing skills and experience of the supervisors and volunteers. It is important that after training, Red Cross Red Crescent volunteers are supervised on a regular basis. See appendix 20 for a list of supervisor job aids, pre-, during and post-campaign. This was produced by the Nigerian Red Cross Society.

LLIN scale-up and hang-up programme

44

International Federation of Red Cross and Red Crescent Societies

Volunteer tasks Volunteer tasks are usually divided into three phases: activities before, during and after the mass distribution. Training should be focused around these three phases and the tasks associated with them.

Volunteer tasks before the distribution ■

■

Social mobilization activities should be undertaken a minimum of five days before the distribution. Activities should include messaging on the net distribution process and who should attend (the target group being clearly defined), why they should attend and where the distribution is taking place. It is important to identify any potential barriers, or families who may be unwilling or unable to attend. Disseminate the dates of the campaign to the community.

Volunteer tasks during the distribution ■ ■ ■ ■ ■ ■ ■ ■ ■

crowd control identifying children’s ages and marking campaign cards administration of non-medical interventions (for example, oral vaccine), only where volunteers have been trained to do so by the ministry of health distribution of nets filling in tally sheets net demonstrations key messaging at site and homes marking nails with indelible ink site maintenance tasks

The duration of net distribution will vary from project to project. The actual distribution of LLINs takes three to six days depending on the target population to be served at each site and may also depend on accessibility of housing and the geography of the area. No matter how many nets are being distributed, every mass distribution programme should include a hang-up component. The objective of hang-up activities is to achieve high net hanging and usage rates.

Volunteer tasks after the distribution ■ ■

Undertake door-to-door visits to carry out hang-up activities in homes. Identify households that did not attend the distribution and advise them regarding where services can be provided.

See appendix 21 for a list of volunteer job aids, pre-, during and post-campaign. Training needs to be well-organized, and if possible standardized. Most importantly, learning objectives need to be set for topics to be covered. Think about what you want volunteers to know and what you want them to do, and plan training activities accordingly. It is advisable to limit the overall duration of training to two days for volunteers and four to five days for training of trainers (supervisors).

Guide / Practical programming steps //

45

Common training problems ■ ■ ■ ■

■

untimely transfer of funds at all levels for training not clearly understanding the link between distribution objectives and activities not estimating enough time to carry out the training National Societies need to have their training curriculum approved by the ministry of health, in good time before the distribution. This can sometimes cause delays for National Society activities not enough time to synchronize messages between the ministry of health and the National Society due to their different programme timelines

See appendices 22 to 25 for examples of data collection forms for volunteers and supervisors. Training should include instructions on filling out forms, as well as information on why the data is necessary and how it is used.

LLIN scale-up and hang-up programme

46

International Federation of Red Cross and Red Crescent Societies

Step 6:

Planning for behaviour change communication, social mobilization and advocacy 1. Definitions Behaviour change communication, social mobilization and advocacy are key components that contribute towards successful LLIN distribution campaigns.

Definitions Behaviour change communication, sometimes abbreviated to BCC, is an interactive and participatory way of facilitating and motivating individuals and communities to change their behaviour to develop positive, healthy and protective practices. Key generic messages can be tailored for specific audiences using a variety of different communication channels. This approach attempts to bridge the gap between the knowledge, attitudes and subsequent behaviour of individuals, families and communities. It requires a good understanding of the audience and the use of a mix of communication channels. Behaviour change communication can be strengthened when supported by advocacy and social mobilization.19 Behaviour change communication is especially important for a successful campaign, as after receiving LLINs, the community must hang, use and maintain them effectively. The BCC module within the malaria toolkit provides a two day training for volunteers on BCC methods and techniques. Social mobilization aims to determine needs and raise awareness of the campaign by mobilizing partners including organizations, groups, networks and communities to work together in a participatory way. The process will help them to build their own capacity to plan, implement and monitor the campaign. Advocacy seeks to promote or strengthen an existing policy, administrative practice or law, and is directed at decision-makers who have the power to enforce and allocate the required resources where necessary. Decision-makers can be influential in the political, social and leadership arena and contribute to making the national campaign successful.

2. Behaviour change communication For more information on behaviour change communication, please see the Behaviour change communication module in the Malaria toolkit.

3. Social mobilization Planning for social mobilization at district level should be carried out well in advance of the campaign as part of the overall district level campaign planning. A communication plan is essential, incorporating behaviour change communication and social mobilization, to promote healthy behaviours while contributing towards the creation of a supportive social environment. A social mobilization plan should include objectives, activities, responsible persons and budget. The campaign is likely to be successful when actions, messages and materials are strategically planned and managed together.

19 Behaviour change communication in emergencies: A toolkit (2006) UNICEF, Regional Office for South Asia.

Guide / Practical programming steps //

47

Social mobilization is most usefully targeted at a range of individuals, families and communities who are well-positioned to pass on key messages, including the following: ■ mothers, fathers and other guardians of children (those who are busy or sceptical about the effectiveness of net use should be particularly targeted) ■ religious, traditional and political leaders ■ teachers and schoolchildren ■ school child-to-child programmes ■ health workers ■ health committees ■ women’s groups or clubs ■ general community members ■ the town crier ■ key decision-makers See also appendix 26. In an integrated campaign, messaging will be integrated to cover all interventions. Messages will be developed with the ministry of health.

3.1 Developing a social mobilization plan The following steps may be helpful when developing a social mobilization plan.20 Step 1: Initial planning ■ Examine the overall campaign objectives and the various social mobilization strategies that can be used to accomplish these. ■ Decide on the roles and responsibilities of the different partners. ■ Plan the timeline for the different social mobilization activities based on when they will have the greatest impact on influencing the population. Identify any specific social or cultural events in the planning period that can be used for disseminating messages in the community as a whole. ■ Reflect on the barriers experienced in past health campaigns and potential solutions. Reach out to the most vulnerable and to those most at risk in order to ensure their participation. ■ Plan how activities will be monitored, documented and reported. Step 2: Undertaking a rapid assessment Plan and undertake a rapid assessment exercise (based on a combination of participatory tools) to assess whether there are any specific cultural practices which could create barriers to LLIN use. Determine who the target groups for the campaign will be and define the behavioural objectives, as well as skills and knowledge available. Social mobilization, especially interpersonal communication, should pay special attention to groups who are less likely to participate. It is important to assess whether any groups are particularly vulnerable. This may include people who are hard to reach (nomadic or migratory), in a minority, marginalized, underserved, internally displaced persons, people living with HIV participating in Red Cross Red Crescent home-based care programmes, or people who show a particular resistance to the campaign. For examples of key messages for the campaign on malaria, measles, polio, vitamin A, deworming treatment, and an example of key targets for social mobilization, please see the appendices and the accompanying CD. Step 3: Determine details of the plan Decide what to include in the plan as follows: ■ which materials to use (including those produced jointly with the ministry of health and other NGOs, and based on existing and previously tested supports)

20 Behaviour change communication in emergencies: A toolkit (2006) UNICEF, Regional Office for South Asia.

LLIN scale-up and hang-up programme

48

International Federation of Red Cross and Red Crescent Societies

■

■ ■ ■ ■

which communication channels will be the most effective for the campaign and for whom including: ❏ health talks (one-to-one basis) ❏ health talks (in small groups) ❏ community meetings ❏ household visits ❏ drama (local theatre, puppetry, dancing) ❏ stories ❏ songs ❏ traditional entertainment ❏ local media (radio and television) ❏ leaflets, posters, banners ❏ public address systems or the town crier what resources are actually available, and what resources local authorities and other groups or organizations may be able to contribute other activities which need to be undertaken, including the timeline for them to be completed where the activities will take place, and the best possible use of existing, regular or planned events, for example, religious services or gatherings, national or regional holidays the specific roles of National Society staff and volunteers and how they relate to other partners participating in social mobilization activities

Before implementing the plan, it is important to pre-test the messages with the different target groups. Messages need to be clear, easy to understand and action-orientated. It is clear that “word of mouth” is central in informing and convincing beneficiaries of the importance of participating in the LLIN distribution. Step 4: Implementing the plan For implementation of the plan it is important to choose the right combination of channels through which communication will be disseminated. This is based on an understanding of how families obtain and share information, and whether they have access to radio and television. The following locations are appropriate for social mobilization activities: ■ religious centres ■ schools ■ market places ■ public gatherings ■ water points ■ ceremonies ■ houses and homes Determine whether objectives set for the campaign have been reached and how social mobilization activities have contributed to its success. It is very important to have both the participation of the community and its leadership in the campaign. Similarly, it is important to work through key administrative committees such as those that may have been formed during previous health campaigns and health activities. Good management of social mobilization is one of the keys to a successful campaign.

3.2 Social mobilization and behaviour change communication activities for volunteers Activities in districts and communities should start six weeks before the start of the campaign and be intensified two weeks before the start date. Activities can include the following: ■ Announce the days when the LLIN distribution will take place at all community meetings, religious gatherings, sporting and cultural meetings. This can be through megaphones and the use of town criers.

Guide / Practical programming steps //

■ ■

■ ■ ■ ■

49

Undertake a media campaign, in particular using the radio to announce distribution days and times, or use television announcements where possible. Radio and television are often expensive channels of communication. If the National Society is going to pay for radio messages, consideration should be given to key times that people are listening to the radio (e.g. popular programmes, news broadcasts), so that any investment can be targeted to maximize reach. National social mobilization committees should work closely with the press and other media to plan dates, times, frequency and content of media messages, and press releases. Carry out house-to-house and school visits with clear messages on the importance of collecting a LLIN and correctly hanging and keeping it up. Make individual visits to key people, including religious, traditional and political leaders, to inform them about the campaign. Develop materials such as banners and bibs to identify Red Cross Red Crescent workers and their place of work during the campaign.

3.3 Preparing and distributing materials The larger campaign partners often fund the production of information and promotional materials. Materials used during a mass campaign may include posters and leaflets, and they should be designed to make them culturally specific and relevant for communities. In areas with low literacy, images should be used to ensure messages are clear. Examples of materials with key messages on malaria, which are useful for promotional materials, can be found in the appendices . They include information on the transmission, treatment and prevention of malaria, and in particular the hanging of nets. Also included are examples of key messages for an integrated campaign. Other Red Cross Red Crescent materials included in the CBHFA module can be adapted to use in a campaign, in particular for malaria and measles.

3.4 Budgeting for social mobilization activities Funding may be needed for: ■ campaign briefing meetings for leaders and community groups ■ small low-cost incentives for local mobilizers and announcers ■ informational and promotional materials ■ radio and television spots ■ training for volunteers on the implementation of social mobilization activities ■ transport ■ activities to launch the campaign The social mobilization budget should be reflected in the overall district plan. Funds sent from the national level need to be disbursed to districts early so that social mobilization activities can be conducted well in advance of the scheduled campaign days.

4. Advocacy Advocacy at all levels of the political and administrative spectrum is a very important activity to undertake when running a mass distribution campaign. There are a number of key stakeholders to whom advocacy should be targeted, ranging from the main decision-makers at government level to those at community level. Advocacy is particularly important during the preparatory phase of a campaign and can help the ministry of health to obtain a high level of commitment from the national authorities, decisionmakers, health practitioners, religious leaders, major partner agencies and donors. It is important that the media are fully aware of the importance of the campaign in order to gain their support. Advocacy is also crucial at the district and local level when preparing for the campaign, particularly when persuading local leaders (including religious) and key groups to support the campaign, and to build community acceptance and support.

LLIN scale-up and hang-up programme

50

International Federation of Red Cross and Red Crescent Societies

National Societies have a key role to play in advocacy, particularly at the district or branch level when working with partners, organizations and the local media. Appropriate advocacy messages at the local level include: ■ the extent of the burden of malaria on the country and the community and the need to control it ■ the social and economic benefits of reducing malaria ■ the need for funds to fulfil specific objectives and government contributions (for transporting and warehousing nets) that demonstrate the government’s ownership and commitment to the campaign ■ the effectiveness of using LLINs in reducing morbidity and mortality from malaria, particularly in young children The following tools for behaviour change communication and social mobilization are available in the appendices: ■ basic facts about malaria such as transmission, signs and symptoms, treatment, hanging and use of LLINs, and key messages for the campaign ■ other examples of key messages for malaria ■ key targets for social mobilization ■ example of a district micro-planning template ■ other examples of recording formats for social mobilization ■ steps to demonstrate net hanging

Guide / Practical programming steps //

Step 7:

51

Child protection 1. Introduction All children, girls and boys, deserve to be safe. However, violence against children is a widespread global problem. It is present among all ethnic groups and all communities. No one is left untouched, and it has an impact on children, their families and their communities.

Violence against children: statistics In the world The United Nations (Pinheiro, 2006)21 reports that in the world: ■ 150 million girls (14 per cent of the planet’s child population) and 73 million boys (7 per cent of the planet’s child population) are sexually abused in any 12-month period ■ only 2 per cent of the world’s children are protected from all forms of abuse in all settings In Africa ■ More than 50,000 African children are involved in prostitution and pornography. ■ World Vision found more than half the children living in displacement camps in Africa’s Great Lakes region have experienced some form of sexual abuse. In some camps, the level is as high as 87 per cent (Kamatsiko, 2006).22 ■ In West Africa, Save the Children and UNCHR found that more than 40 humanitarian agencies and aid workers were accused of sexual exploitation and abuse of children in emergency settings. Similar allegations have been made around the world. ■ A study in Swaziland by UNICEF (2007)23 found one in three women experienced some form of sexual violence as a child, nearly one in four experienced physical abuse and 30 per cent experienced emotional abuse. ■ The African continent has the highest number of child soldiers in the world. There are an estimated 120,000 children fighting in African conflicts (TransAfrica Forum, 2000).24

2. Why children need protection A child is defined in the United Nations Convention on the Rights of the Child25 as “every human being under the age of 18 years unless, under the law applicable to the child, majority is attained earlier”. Children are more vulnerable to abuse of power than adults due to several factors: age ■ size ■ lack of maturity ■

21 Pinheiro, P.S. (2006) World report on violence against children, United Nations. Available from: www.violencestudy.org/IMG/pdf/English-2-2.pdf. 22 Kamatsiko, V.V. (2006) Their future in our hands: Children displaced by conflicts in Africa’s Great Lakes Region, World Vision. Available from: www.worldvision.org.uk/upload/pdf/Their_future_in_our_hands.pdf. 23 United Nations High Commissioner for Refugees (UNHCR) and Save the Children, United Kingdom (2002). Note for implementing and operational partners by UNHCR and Save the Children UK on sexual violence and exploitation: The experience of refugee children in Guinea, Liberia and Sierra Leone based on initial findings and recommendations from assessment mission 22 October–30 November 2001. Available from: www.unhcr.ch/cgi-bin/texis/vtx/partners/opendoc.pdf?tbl=PARTNERS&id=3c7cf89a4. 24 Taylor, K. (2000) Child soldiers in Africa: The problem and the solutions fact sheet, TransAfrica Forum. Available from: www.transafricaforum.org/reports/child_soldiers.pdf. 25 United Nations (1989), United Nations Convention on the Rights of the Child. Available from: www2.ohchr.org/english/law/crc.htm.

LLIN scale-up and hang-up programme

52

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■

lack of experience less power limited knowledge dependence for basic needs

Because of these special risks, children need protection from: ■ physical, sexual and emotional abuse ■ trafficking and sexual exploitation ■ violence, including sexual violence as a weapon ■ military recruitment ■ family separation, abandonment or being orphaned ■ abduction and forced confinement Violence against children can occur in many settings. Abuse can occur in a child’s: ■ family ■ school ■ institutions (including orphanages, religious institutions, prisons, hospitals) ■ workplaces ■ community (including camps for refugees internally displaced persons)

3. Violence against children Violence against children is any form of physical, sexual or emotional mistreatment or a lack of care that causes harm to a child. Abuse is a form of violence against a child. Abuse of power is common to all types of child abuse. Although different types of abuse are often studied as unique forms, abused children usually face multiple forms of abuse. Violence and abuse are complex issues that require a multifaceted prevention approach. There are no easy or quick solutions. Although solutions are complicated, violence is not inevitable and it can be prevented. Creating awareness, developing protective systems, policies and laws, and supporting families and children can all help stop abuse against children. See appendices 27 and 28 for more information on child protection.

4. Sexual abuse and exploitation Sexual abuse and sexual exploitation can be defined as follows. ■ Sexual abuse occurs when a younger or less powerful person is used by an older or more powerful child, adolescent or adult for sexual reasons. ■ Sexual exploitation is an actual or attempted abuse of position of vulnerability, differential power or trust for sexual purposes. This includes profiting economically or socially from the exploitation. Children and young people are unable to give consent because they do not have equal power, equal knowledge or equal support systems. Sexual abuse is a betrayal of trust and it robs children of their childhood.

Types of sexual abuse Child sexual abuse falls under two categories: contact and non-contact. Each includes a wide range of behaviours.

Contact

Non-contact

■

touched in sexual areas

■

shown sexual videos and pornography in person, via internet or mobile phone photos

■

forced to touch another’s sexual areas

■

forced to listen to sexual talk, including obscene telephone calls

Guide / Practical programming steps //

53

■

embraced or held in a sexual manner

■

forced to pose for seductive or sexual photos or videos

■

having sex with a child: vaginally, anally or orally

■

forced to look at the sexual body parts of another person

■

physically and sexually tortured

■

forced to watch sexual acts

■

using objects to sexually penetrate a child’s body

■

teased about sexual body parts

■

subjected to intrusive questions, comments, or observations, verbally, or through notes, e-mail, chat rooms or text messages

■

made the object of voyeurism or unwanted watching

5. Physical abuse Physical abuse is defined as when a person in a position of power or trust purposefully injures or threatens to injure a child. This can include hitting, shaking, burning, slapping or kicking a child. Physical abuse is usually connected to physical punishment or is confused with discipline.

6. Family violence Family violence is defined as any action in a family that causes physical, sexual or emotional harm to another person in the family. This includes hitting, humiliating or isolating any person in the family.

7. Emotional abuse Emotional abuse is defined as an ongoing attack on a child’s self-esteem; it is psychologically destructive behaviour by a person in a position of power, authority or trust. It crushes a child’s sense of worth and self-esteem. Emotional abuse can include regularly ignoring, isolating, insulting, scaring and threatening a child. While physical scars may heal, emotional hurt may continue to cause pain long after the abuse occurs.

8. Neglect Neglect is defined as the chronic failure to meet children’s basic needs such as shelter, nutritious food, adequate clothing, education, medical care, rest, safe environments, exercise, supervision, and affection and care. Denying children their basic physical, mental, emotional and/or spiritual needs at any stage of childhood can have many impacts, including poor development, ill-health and even death.

9. Impact of abuse Children’s reactions to violence and abuse are age, gender and culturally specific but all suffer hurt. Common impacts include: ■ powerlessness ■ problems with trust ■ betrayal ■ sexualization Children not only suffer the physical pain of being injured and traumatized, but are also left with psychological hurt, shame and often self-blame. Children need to know that abuse is never their fault. Red Cross Red Crescent staff and volunteers should never: ■ hit or physically harm a child ■ develop physical or sexual relationships with children

LLIN scale-up and hang-up programme

54

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■ ■ ■

use language, gestures or other behaviours that are sexual with children use language, gestures or behaviours that scare, degrade, humiliate, reject, isolate, corrupt or terrorize a child intentionally view, download or distribute any sexualized, demeaning or violent images involving children take pictures of children that can be interpreted as sexualized, demeaning or violent develop relationships with children that can be considered exploitative, violent or abusive spend time alone with children, in isolation, away from the observation of others. Interactions with children should always be visible to others or there should be at least two staff members with a child in an isolated location

10.How and why abuse happens Although violence occurs between people, it is caused by a combination of individual, family, community and social or cultural factors. These factors are connected and together increase the vulnerability of hurting others or being hurt. The ecological model (Krug et al., 2002)26 combines the many theories of violence. Acohol/substance abuse Victim of abuse Anger issues

Violence in family Poor parenting practices Poverty

INDIVIDUAL

FAMILY

High crime levels Poverty Few community support systems High unemployment

COMMUNITY

Violence tolerated Conflict/disaster Small arms available Gender inequality Rapid social change Group discriminated against

SOCIETY/ CULTURE

11.Laws to protect children In 1989 the General Assembly of the United Nations adopted the Convention on the Rights of the Child. India ratified the convention on 2 December 1992. To date, 192 countries have signed and ratified this document. The convention provides children with the rights to: ■ survival ■ safety and protection ■ health ■ participation ■ education In 1999, the African Charter on the Rights and Welfare of the Child entered into force. The charter gives all African children comprehensive rights, including the right to be free from violence and abuse. Each country also has its own child protection laws. Local laws should be followed by and familiar to all staff and volunteers in the International Red Cross and Red Crescent Movement.

26 Krug E et al. (eds) (2002) World Report on Violence and Health, World Health Organization.

Guide / Practical programming steps //

55

12.Reporting child protection concerns Children may not disclose abuse because they may: ■ be frightened ■ try to pretend it did not happen ■ be taught abuse is normal ■ be in denial ■ still like or love the person who has hurt them ■ feel guilt or that it is their fault ■ not know who to tell ■ not want to get into trouble ■ be embarrassed and ashamed ■ fear they will break up the family ■ do not realize what happened was wrong Accidentally or purposefully, the abuse may be revealed. Regardless of how it becomes known, either in words, artwork or behaviour, disclosures are usually mixed with strong emotions such as relief, guilt, fear and chaos, because now someone else knows their secret. However abuse is disclosed, it needs to be handled sensitively.

Responding to disclosures of abuse When abuse is suspected or when abuse is disclosed, the priority is to ensure the child is safe. Everyone in the International Red Cross and Red Crescent Movement has a responsibility to act: ■ Acknowledge the child’s situation and feelings: “I am sorry this happened to you”. ■ Access support and help. ■ Comfort the child and take him or her to a safe place: “Let’s try and get some help”. ■ Carefully listen to what the child says. ■ Take notes and document what the child says and/or what you see. ■ Take action and report the abuse immediately. Child abuse is against the law. If you know or have reasonable grounds to suspect that a child is being abused, immediately report your concerns according to local laws. You may also report your concerns to your supervisor, human resources or senior leadership within the National Society. For all reports, the “Reporting form for disclosures of violence against children” should be completed and provided to the appropriate person within the National Society.

13.Protective factors Although children are vulnerable to being hurt, they can be protected. When children are given support in families and communities, provided healthy role models, feel connected to their family, culture and community, and are surrounded by caring, non-violent relationships, their risk of harm is reduced.

14.Conclusion Violence is a problem that affects boys and girls of all backgrounds. While risks always exist, all children can be protected from harm. People who work with children, families and communities in supporting their health and safety have a valuable role to play. Although violence is a complicated issue, it is not inevitable. The abuse against children caused by violence is preventable. Children, families and communities can be safe. Please see appendices for further information on: ■ Fact sheet for volunteers: All children deserve to be safe! (appendix 27) ■ Training curriculum for training trainers and training volunteers (appendix 28) ■ Report form for disclosures of violence against children (appendix 29)

LLIN scale-up and hang-up programme

56

International Federation of Red Cross and Red Crescent Societies

Step 8:

Hang-up activities Hang-up is an activity that volunteers undertake to ensure that all LLINs that are distributed are correctly hung and used. Hang-up is often built into the social mobilization for the campaign (immediate post-campaign door-to-door activities), but is also an activity that can be used prior to peak transmission periods to ensure nets are hanging and used. Given large seasonal variations across countries, hang-up should be planned for periods when it will have the greatest impact on reducing transmission of malaria. Hang-up activities can also be integrated into ongoing community health programmes undertaken by National Societies. Programmes focused on water and sanitation, HIV/AIDS, mother-child health and others can include simple messages about net utilization either consistently or at peak transmission periods. Hang-up is an activity that should be planned from the beginning of the campaign planning period. It should be included in plans of action and chronograms of activities that are part of the initial planning. National Societies have a number of ways of participating in campaign activities: 1. Participation in pre-campaign mobilization and hang-up activities post-campaign. 2. No participation in the campaign, but implementation of a hang-up programme following a mass distribution.

Planning for hang-up Hang-up is a key activity that should be considered from the outset of campaign planning. National Societies should view the campaign and post-campaign activities as a single programme, with different parts funded by different partners. National Society hang-up activities should be discussed with the ministry of health, as they may have specific areas where the efforts of Red Cross Red Crescent volunteers should be targeted due to barriers to net use or low access to health services. Hang-up is an activity that can be implemented at any scale, whether community, district, region or nation. Where hang-up is tied to pre-campaign social mobilization, normally training for preand post-distribution activities will take place simultaneously due to time, logistic and budgetary constraints. In this situation, the social mobilization training for volunteers and supervisors needs to cover the hang-up material in addition to all the other pre- and during campaign activities. Given that social mobilization training will take place anywhere from two to six weeks prior to the campaign (for commencement of pre-campaign messaging one week prior to the campaign), implementers should be aware that volunteers may forget some of the hang-up duties by the time hang-up activities occur (in some cases this could be three months after the training). Based on their training curriculum, a list of key reminders to jog the volunteers’ memories should be developed by the National Society. Supervisors can give these to volunteers after the campaign activities are over and just before the hang-up activities begin. Where a National Society has not participated in pre-campaign social mobilization and is only undertaking hang-up activities, a minimum training package, based on the International Federation tools for keep-up, should be developed to ensure correct and consistent messaging and activities. A list of key reminders for supervisors and volunteers should be included in the training materials and job aids. When planning for hang-up, the National Society should determine what their objectives will be and how these objectives will be measured for post-activity reporting. Assessing the effectiveness of volunteer activities on improved rates of net hanging is important for demonstrating the role of the Red Cross Red Crescent volunteers in community health.

Key activities to be included in the activity plan It should be noted that many of the following items, such as community sensitization and selection of volunteers/supervisors will have occurred at the time of social mobilization and will not need to be repeated.

Guide / Practical programming steps //

57

Key activities to be included in the activity plan are: ➥ Determine number and placement of volunteers and supervisors. This is a critical first step in ensuring adequate coverage of households. The number of households that one volunteer can cover varies widely depending on spacing of households and villages. A volunteer in a rural area will be able to cover many more households than a volunteer in an urban area. It should be kept in mind that volunteers should be recruited from their own communities. Transportation can, in this way, be kept to a minimum (for training only). For hang-up activities, an average target number of households per day should be established, with the knowledge that this will vary depending on community location. ➥ Pay close attention to the volunteer to supervisor ratio to ensure adequate support and quality control of volunteer effort. This is particularly important in terms of quality control of compilation of forms. If one supervisor has a large number of volunteers and thus many forms to compile, he/she is likely to cut corners. A volunteer to supervisor ratio of around one to twenty-five is recommended. ➥ Draft logframe, including monitoring and evaluation plan with examples of goals, objective and indicators such as: ■ Goal: to reduce the incidence of malaria among the target population in X location ■ Objective: to increase the number of target population in X location who correctly use a LLIN ■ Indicators: ❏ percentage of target population in households visited who slept under LLIN night before visit ❏ percentage of households with at least one LLIN hanging ❏ percentage of households visited who were assisted with hanging nets ❏ and many more…. ➥ Adaptation of malaria technical training materials, including job aids. All materials and job aids should be pre-tested and modified according to feedback received during the pretest to ensure they are acceptable and effective. ➥ Adapt monitoring forms that will be used for data collection during hang-up activities. Volunteers will collect data on household visit forms and the coach or supervisor then collates this data, for reporting to the regional or national level health coordinator. An example of hang-up data collection forms is included in appendices 30 and 31. The monitoring forms should be pre-tested and adapted for messages and job aids.

Key activities at the implementation stage ➥ Selection and recruitment of supervisors. Where the National Society did not participate in the campaign, this activity will need to take place three to four months prior to the start of activities. In countries where the National Society participated in campaign activities, hangup activities that are not tied to the campaign implementation itself should reactivate the network of volunteers that was mobilized during the previous activities. Criteria for selection of supervisors, as well as their role and responsibilities, should be clear prior to the beginning of the recruitment process. ➥ Selection and recruitment of volunteers. As noted above, volunteers for hang-up activities should come from the communities where the activity will take place. This way, they will understand the cultural context, as well as have established personal relationships with community members, which will enable them to modify messaging for their own situation. As for supervisors, criteria should be established for the profile sought for volunteers, and roles and responsibilities should be made clear from the outset. ➥ Community sensitization. An important part of undertaking hang-up (or other communitybased) activities is ensuring that the community leaders and influential members of the village are informed which activities are taking place and why. Ideally, these community sensitization meetings should take place in collaboration with representatives from the ministry of health. ➥ Training of supervisors. A training of trainers (for the supervisors) should be organized in a central location. Agenda should be organized for feedback from the ministry of health and partners. Materials should be adapted from the numerous existing manuals, job aids and

LLIN scale-up and hang-up programme

58

International Federation of Red Cross and Red Crescent Societies

recording guidelines available. Training for supervisors should include modules on training and supervision skills, data collation and financial and narrative reporting. Materials for the training of volunteers, as well as articles for identification such as bibs or t-shirts, should be given to the supervisors for use and distribution during the training of volunteers. ➥ Training of volunteers. Volunteer training sessions should be organized in a rolling fashion immediately following the supervisor training. Supervisors will have materials to conduct the training, as well as guidelines and job aids for use by the volunteers. The volunteer training should include role-play, pre-testing of activities and messages, behaviour change communication skills and mock trials of filling in the necessary activity forms. ➥ Conduct hang-up activities. Once the volunteers have been trained, they should start the house-to-house and community mobilization activities for which they have been trained. Regular reports should be sent to the supervisors according to the established timelines.

Guide / Practical programming steps //

Step 9:

Monitoring of activities See Malaria Assessment module

Step 10:

Evaluation of activities See Malaria Assessment module.

59

LLIN scale-up and hang-up programme

60

International Federation of Red Cross and Red Crescent Societies

Evaluation form for Malaria toolkit: Long-lasting insecticide nets scale-up and hang-up programme Users of the toolkit are invited to assist in an evaluation of the LLIN module and associated appendices. Your feedback will be used in any future updating of the module and useful suggestions incorporated. Please score the following areas: 5 = Very useful, 4 = Useful, 3 = Mostly useful, 2 = Not very useful, 1 = Not at all useful. Please add comments if you wish. These will help us to find the best way to keep the material up to date and of most use to you in your fight against malaria.

Comments Overall impression

5

4

3

2

1

Coverage

5

4

3

2

1

Language, tone, style

5

4

3

2

1

Applicability to the planning of a mass LLIN distribution programme

5

4

3

2

1

Advocating good practice

5

4

3

2

1

Relevance and ease of use of practical programming procedures and practices described in the module

5

4

3

2

1

Relevance of items included in the Appendices

5

4

3

2

1

Can you suggest any additional topics or materials that might be helpful?

Can you list any specific recommendations for deletion or correction?

Guide / Practical programming steps //

Finally, please complete this section and return the form to the address given below. Your name (surname): First name: Position and title: Red Cross Red Crescent Society: Full address:

Phone: E-mail:

Please photocopy and return to: Jason Peat, Senior Health Officer, Malaria International Federation of Red Cross and Red Crescent Societies P. O. Box 372 1211 Geneva Switzerland E-mail: [email protected]

61

Appendices

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

Appendix 1

Roll Back Malaria: The Global Malaria Action Plan*

* Some images removed. See www.rbm.org or inforbm.who.int for full version.

63

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

64

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

65

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

66

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

67

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

68

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

69

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

70

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

71

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

72

Appendix 1 / Roll Back Malaria: The Global Malaria Action Plan //

73

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

74

Appendix 2 / HIV and malaria //

Appendix 2

75

HIV and malaria Malaria prevention in Red Cross and Red Crescent HIV and AIDS programmes Background Malaria and HIV, two of the most significant contemporary global health problems, collectively account for more than four million deaths annually. Malaria accounts for more than a million deaths per year, of which about 90 per cent occur in tropical Africa, where malaria is the leading cause of death in children under five years of age. Aside from young children, pregnant women are among the most affected by the disease.1 The HIV and AIDS pandemic has had a fundamental impact on the world, killing more than 25 million men and women, orphaning millions of children, exacerbating poverty and in some countries in sub-Saharan Africa, hindering and even reversing sustainable development. Worldwide, more than 40 million people are living with HIV today, half of them women. HIV and AIDS increasingly accounts for a large proportion of mortality among children under five years of age in the most affected countries in sub-Saharan Africa.2

The Interaction between malaria and HIV and AIDS Malaria and HIV and AIDS mutually reinforce each other and contribute synergistically to morbidity, mortality and burden on health systems3. HIV and AIDS and malaria are highly endemic and there is a wide geographic overlap in sub-Saharan Africa. The most severely affected countries are Cameroon, Central African Republic, Malawi, Mozambique and Zambia, where more than 90 per cent of the population is exposed to malaria and HIV prevalence (among adults 15–49 years of age) is more than 10 per cent. The two diseases also overlap in South-East Asia, Latin America and several Indian cities. The resulting co-infection, the interaction between the two diseases has major implications for public health. The consequences are particularly serious for reproductive health. Co-infection in pregnant women puts them at high risk of anaemia and malarial infection of the placenta. A large proportion of children born to co-infected mothers, have low birth rate and are more susceptible to illness and/or death in infancy. Co-infection of malaria in people living with HIV (PLHIV) is an additional burden and increases the risk of developing severe malaria with fatal consequences, particularly for people with suppressed immune systems. People with low CD4 counts may also be more susceptible to treatment failure of anti-malarial drugs. Acute malaria episodes temporarily increase viral replication, therefore, HIV viral load, which may increase susceptibility to opportunistic infections. In general, there is an increased risk of illness and anaemia in co-infected adults and children. People with malaria-induced anaemia may require blood transfusions, which may pose a risk factor for HIV infection where the safety of blood supplies is not guaranteed. This may also pose 1 WHO 2004 Malaria and HIV/AIDS Interactions and Implications 2 UNAIDS Report on the Global Epidemic 2006 3 World Malaria Report 2005

LLIN scale-up and hang-up programme

76

International Federation of Red Cross and Red Crescent Societies

an increased risk of mother-to-child transmission of HIV if the pregnant woman is infected through a contaminated blood transfusion.

What the International Federation is doing to reduce the risk of and complications due to malaria among people living with HIV. The International Federation supports access to malaria and HIV anti-retroviral (ARV) treatments for those requiring treatment, and free access to long-lasting insecticide treated bed nets (LLINs) to people living with HIV through home- and community-based care and support programmes implemented in malaria-endemic areas.

Interventions ■

■

■

■

Support and strengthen National Society volunteer management systems to ensure high level community education and social mobilization for malaria, HIV and AIDS, and other health interventions. Follow-up after large scale integrated LLIN distribution campaigns and during routine distribution and vaccination services to sustain high coverage achieved in mass campaigns and to ensure proper hanging and consistent usage of LLINs. Distribute LLINs to people at high risk of malaria infection such as pregnant women, people living with HIV and chronically ill people through National Society home-based care programmes. Health promotion and education at community level focusing on the importance of early treatment of malaria and HIV, and malaria prevention.

Outcomes ■ ■ ■ ■ ■ ■

Strong and capable National Societies ensuring high awareness and positive health-seeking behaviours at community level. Integration of LLINs in National Society community-based health programmes targeting groups at highest risk (people living with HIV and chronically ill people). High household LLIN ownership and correct usage of LLINs among those at highest risk. Reduction in illnesses and deaths from malaria, and other preventable diseases in target areas. Contribution to achievement of Millennium Development Goals and achievement of the Abuja Declaration LLIN targets for household ownership and usage. Expanded and trained volunteer base; monthly house-to-house visits by Red Cross and Red Crescent volunteers; increased visibility of National Societies at local and national level; and stronger partnerships and co-operation with ministry of health and other actors.

Strategic approach ■ ■ ■

Integrate LLINs distribution to HIV home-based care clients where large-scale integrated campaigns occur. Seek and develop new partnerships like World Swim Against Malaria and fundraise for additional LLINs for distribution among groups at highest risk. Distribution of ITN/LLIN as ‘minimum standard’ in all Red Cross and Red Crescent HIV and AIDS home-based care programmes implemented in malaria-endemic areas.

Partners International Federation of Red Cross and Red Crescent Societies, Swedish Red Cross, Canadian Red Cross, Norwegian Red Cross, Finnish Red Cross, American Red Cross, UNICEF, WHO, Roll Back Malaria, ministries of health, World Swim Against Malaria.

Appendix 3 / Malaria fact sheet //

Appendix 3

77

Malaria fact sheet – Kenya 2006

What is malaria? Malaria is a very serious disease caused by a parasite called plasmodium. It is the most common and dangerous type of parasite that can kill a child within 24 hours of onset.

How is malaria transmitted? The parasite is transmitted by the bite of a mosquito which bites an infected person and passes the parasites to a non-infected person.

What are the signs and symptoms of malaria? Signs and Symptoms of Uncomplicated Malaria History of fever, or one who feels hot (children), should immediately suspect malaria and attend the nearest health facility for treatment. Other signs of malaria include: headache, joint and muscle pain, abdominal pain and generalized weakness. Children suffering from malaria may refuse to feed and vomiting may occur.

Signs and Symptoms of Severe MalariaSevere malaria is most common in children under five and pregnant women and is characterized by some or all of the following symptoms: ■ Inability to eat or drink and/or vomiting everything; ■ Convulsions, lethargy or loss of consciousness; ■ Difficulty breathing; ■ Signs of low blood sugar (sweating, abnormal breathing, coldness, pupil dilation); ■ Passing little urine or urine that has the colour of Coca-Cola;

LLIN scale-up and hang-up programme

78

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■

Jaundice (yellowing of the eyes, palms or feet) and anaemia; Prolonged bleeding from injection sites, gums, etc; Circulatory collapse or shock (cold extremities, weak and rapid pulse); and Prostration i.e. generalised weakness so that the patient cannot walk or sit without

How do you treat malaria? In Kenya, the drug policy has recently changed from provision of sulphur based drugs to ACTs (Artesunate Combined Therapy) for episodes of uncomplicated malaria. ACTs for treatment of malaria in children under five and pregnant women are available. Severe malaria must be treated with quinine by a health practitioner at a health facility and the patient must be closely monitored. If malaria is untreated, the patient risks developing severe malaria (complications listed above) and death.

Who is at risk of contracting malaria? Everyone is at risk of malaria. The most vulnerable groups for malaria infection are: children under five years of age, pregnant women, people with HIV/AIDS and the elderly.

How do you prevent malaria? The best way to prevent people from contracting malaria is to reduce exposure to Anopheles mosquitoes that carry the parasite. Anopheles mosquitoes typically bite most between dusk and dawn. Long-lasting insecticidal nets (LLIN) are proven to be an effective and cost efficient tool for malaria control. LLINs have a number of advantages: ■ Protection from mosquito bites ■ Cost-effectiveness ■ Kills all crawling insects ■ Reduces morbidity and mortality in children under five due to malaria Key messages about malaria ■ The only cause of malaria is mosquitoes. ■ Malaria is a very serious disease that can quickly lead to death. ■ The most vulnerable groups are children under five years and pregnant women. ■ LLINs are an effective method of preventing malaria infection at low cost. ■ LLINs should be aired outdoors in the shade for 24 hours prior to use.

Appendix 4 / Example of plan of action for social mobilization, integrated measles malaria programme //

Appendix 4

79

Example of plan of action for social mobilization, integrated measles malaria programme Nigerian Red Cross Society – National Headquaters Abuja Plan of action for social mobilisation in cross river december 2008, integrated measles malaria campaign from august 1st – december 23rd 2008

Background

Nigeria conducted its integrated measles “catch up campaign” in 2005 and 2006 and documented more than 95% decline in measles cases. It is important that follow-up mass campaigns are conducted periodically (every 2 -3 years) to maintain low levels of susceptibility. This is because being one of populous countries in Africa, is a priority which requires a closer attention to ensure it achieve the goal of 90% reduction in measles mortality by the year 2010 as compared to 2000 estimates as described in the WHO/UNICEF Global Immunization Vision and Strategy (GIVS). Malaria remains an important cause of childhood mortality, especially in developing countries. The use of Insecticide Treated Nets (ITNs) for malaria prevention is one of the key interventions in the Roll Back Malaria (RBM) programme in Nigeria. About 706,186 LLINs was allocated for distribution in 34 local government authorities (LGAs) in 18 States during the January round 2007 of immunization campaign in Nigeria; with the intention of rapidly increasing ITN coverage and use, increasing the coverage of routine immunization and contributing to interruption of transmission of the wild polio virus by reducing the zero-dose non-polio Acute Flaccid Paralysis (AFP) cases to under 10% in the LGA where LLINs were distributed. The Long-Lasting Insecticidal Nets (LLINs) procured through support from United Nation Foundation (UNF), Exxon

LLIN scale-up and hang-up programme

80

International Federation of Red Cross and Red Crescent Societies

mobil and the Global Funds for Acquired Immunodeficiency Syndrome (AIDs) Tuberculosis and Malaria (GFATM) were utilised in this exercise. Although ITN use has increased from 2.2% in the year 2003 to 6.8% in 2005, it remains considerably under the Abuja target of 60%, the level at which a major impact on malaria burden would be expected. Immunization coverage in the country too is still very low. The Diphtheria Pertussis Tetanus vaccine – third dose (DPT3) coverage at national level in 2005, based on administrative data, was 37.5%. In addition, year 2005 saw Nigeria registering 801 confirmed polio cases. In Nigeria nearly half of the population lives on less than $ 1 per day, and the less prevailing socioeconomic conditions the lower the average at which children are attacked with measles and malaria. While Nigeria Red Cross and other partners were trying to achieve high routine immunization coverage of (>90%) in Nigeria, the follow-up campaign in 2008 will help to reduce the number of cumulative susceptible and sustain the gains already documented.

Burden of Malaria in Nigeria: Trends and Current Status Malaria Cases in Nigeria 1991-2005 3,500,000

Malaria Cases

3,000,000 2,500,000 2,000,000 1,500,000 1,000,000

2005

2004

2000

1989

1988

1987

1986

1985

1984

1983

1982

0

1981

500,000

Years

Year

Reported under-5 Deaths

1999

4820

2000

5157

2001

5498

2002

4717

2003

4653

2004

3654

General Objective

Data from Epidemiology Department, FMOH Malaria is a major public health problem in Nigeria, accounting for about 60% of all outpatient attendances and 30% of all hospital admissions. There is an estimated 110 million clinical cases and an estimated 4,500 deaths in children under 5 years per year, including up to 11% of maternal mortality. Malaria’s economic impact is enormous with about 132 billion lost to malaria annually in form of treatment costs, prevention, loss of man hours etc.Reduction in GDP has not yet been quantified, but is likely substantial, with regional estimates suggesting a deficit of 1.5% GDP growth. Malaria programme coverage has increased substantially across the country between 2000 and 2005. However, current coverage levels remain considerably under the targeted 60% levels established in the previous plan and far below the levels (>60% coverage) at which major impact of the interventions on malaria burden would be expected. The General objectives of this Nigerian Red Cross Social Mobilization campaign is to contribute to sustaining the reduction in measles morbidity and mortality following the 2005 and 2006 catch-up campaign as well as to increase the coverage and usage of LLINs in Cross River State. Therefore, this social mobilization activity is to increase the knowledge of caregivers thereby helping to increase acceptance and appropriate use of LLINs by the target populations. The National campaign will also target interrupting wild polio virus transmission in ten states, Vitamin A deficiency and malaria a leading cause of childhood morbidity and mortality.

Appendix 4 / Example of plan of action for social mobilization, integrated measles malaria programme //

Objectives

■ ■ ■ ■

Expected Outputs

■ ■ ■ ■ ■ ■ ■ ■

Expected outcomes

■ ■ ■ ■

The strategy

81

Support the MOH distribution of LLINs during the integrated measles malaria campaign in Cross River state. Build capacity at NRCS NHQ and CRS to carry out social mobilisation in Integrated measles malaria campaign. Expand volunteer network and activities in CRS. Increase NRCS visibility in anticipation of future malaria prevention activities in Nigeria.

One National mobilization workshop conducted for 4 NRCS staff. One National training of trainers conducted for 39 Red Cross volunteers and staff from Cross River state. 36 State LGA trainings of 900 volunteers from 18 LGAs in Cross River State. Community mobilization activities conducted in 18 LGAs in Cross River State. 4 types of IEC materials. 8 meetings (2/month) held with MOH /RBM and other stakeholders at NHQ and CRS 1 Sensitization Session of community leaders in each of 18 target LGAs. Reports from regular supervision visit.

Increase in the knowledge and skills of Red Cross Staffs and Volunteers to plan and implement social mobilization activities. Increase in the understanding of parents and members of community networks of the benefits of measles vaccination, routine immunization and LLINs use. Increased knowledge of routine immunization schedule and subsequent increase in RI coverage rates. Increase visibility of NRCS in print and electronic media.

The Nigerian Red Cross Society, MOH and other partners will continue to participate in updating the knowledge of its volunteers: ■ Modification of IEC materials (T shirts, training guide, curriculum and support tools) radio and TV spots etc.) in conjunction with partners and arrange major events such as flag-offs or community related social mobilization activities. Red Cross volunteers will provide a combined role as local guides and communities mobilizers within their communities, and will be responsible for; ■ Gain access to the community through contacts with the community leaders. ■ Community mobilization to create demand for the LLIN and respond in conjunction with the technical team to all questions associated with the campaign. ■ Conduct House to House mobilization using the ongoing Mother to Mother peer education model. This will be done before, during and after the Integrated Measles Malaria Campaign. ■ Provide as needed support to the MOH at the vaccination post during the integrated measles malaria campaign. ■ Track community participation at the vaccination post and follow up non compliance.

Proposed activities to be carried out

In this regard the Red Cross staff and volunteer members are expected to participate in the following activities; ■ Coordinate activities both internally and with other stakeholders. ■ Produce IEC materials in collaboration with MOH and other social mobilization partners. ■ Train 3 NHQ staffs, 39 State Supervisors and 900 volunteers (mothers club members included) on how to conduct an all mother community dialogue within their communities. ■ Intensifying community dialogue sessions 5 days to the implementation days.

LLIN scale-up and hang-up programme

82

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■

Monitoring and Evaluation Indicators

■

■ ■ ■

Reporting

Strategic social mobilization intervention in 18 LGAs of Cross River to promote the uptake of the measles vaccines and LLIN during the campaign exercise. Help organize campaign launch in Cross River state in conjunction with social mobilization team. Track media interaction in both print and electronic. Undertake regular monitoring and supervision visits for quality control and appropriate project implementation.

Monthly supervision and monitoring visits to the state using developed checklist to include at least: ❏ Progress of activities against chronogram ❏ Review of materials developed ❏ Reports from training activities At least 95% of children in households identified by mother’s clubs members are able to access LLIN and using it. 900 Volunteers are trained using the agreed curriculum. All trained volunteers participated in 5 days pre, 5 days during and 5 days post integrated measles campaign activities.

The NRCS will provide regular activity and progress reports on the social mobilization activities and will produce a final project report upon conclusion of the post campaign activities.

Appendix 5 / Template for a Memorandum of Understanding //

Appendix 5

83

Template for a Memorandum of Understanding Memorandum of Understanding XXX Red Cross Red Crescent Society and the Ministry of Health

Introduction

The National Society (NS) and the MoH (MoH), with this agreement, will establish clear roles and responsibilities for the National Integrated Child Survival Campaign that will take place (insert dates).

Objective

To promote close collaboration and cooperation between the MoH structures at national and district levels and the NS headquarters, regional and district branches to implement a successful integrated child survival campaign that reaches a maximum number of beneficiaries.

Duration

This agreement will last 12 months, from (insert dates) (the starting point for meetings between the MoH and the NS) to (insert dates) (the finishing point after the Centers for Disease Control – Atlanta has come to evaluate the impact of the program in (insert dates)).

Activities

The NS activities for the integrated child survival campaign include the following: a. To support the MoH in efforts to improve child health indicators in (insert area to be covered), through the integrated campaign; b. Notification to MoH and Measles and Malaria Task Force of areas covered by the NS and where gaps exist; c. To support the MoH in efforts to attain or exceed all targets set for the various interventions of the integrated campaign; and, d. To increase LLIN coverage and utilization by children under five through volunteer activities before, during and after the integrated campaign.

Intended Impact

A maximum number of children vaccinated against measles, protected against micronutrient deficiency, de-wormed and sleeping under LLINs to prevent malaria, accomplished through efficient and effective working relations between the MoH and and the National Society (and other partners).

Responsibilities

1. Coordination a. National Level ■ The MoH will be responsible for coordinating regular meetings for all interested parties involved in the campaign (coordinating body is either Joint Measles and Malaria Task Force or Joint CCM/ICC body) ■ The MoH will develop sub-committees in the following areas, including team composition and terms of reference for the working groups: ■ Operations ■ Logistics ■ Training ■ Social Mobilization

LLIN scale-up and hang-up programme

84

International Federation of Red Cross and Red Crescent Societies

Administration/Finance and Resource Mobilization Disease Surveillance ■ Monitoring and Supervision ■ Coordination meetings should be weekly or biweekly depending on the status of preparations for the campaign and the timelines remaining for implementation. The MoH will be responsible for inviting members from all participating bodies; ■ The MoH coordinating body for the integrated campaign will be responsible for reviewing the progress of the sub-committees in terms of preparations for the campaign; ■ The MoH will be responsible for: ■ Appointing a reporter for these meetings ■ Circulating minutes from meetings both internally (MoH) and externally to other interested partners for their feedback. Reports should cover progress, identification of problems, suggested solutions to problems, decisions taken and action items for follow-up ■ The NS will be responsible for ensuring that, at minimum, one representative is present at each meeting. b. District Level ■ The District Health Management Team (DHMT) will be responsible for organizing regular coordination meetings for the Integrated Child Survival Campaign. These meetings may be integrated with the coordination meetings already occurring for integrated health activities; ■ The MoH DHMT will be responsible for circulating minutes from all meetings internally (MoH) and externally to other interested partners at district level. ■ The NS will be responsible for ensuring that, at minimum, one representative is present at each meeting. ■ ■

2. Communications ■ MoH, at all levels, will be responsible for ensuring that minutes of coordination and subcommittee meetings are circulated so that partner organizations, including the NS, can act within the mandate and framework of the integrated campaign. ■ NS will be responsible for ensuring that headquarters and district level offices, personnel and volunteers are aware of MoH decisions and act according to the national plan.

3. Social Mobilization ■ NS will be responsible for social mobilization activities of NS volunteers throughout the country as part of the national social mobilization plan; ■ The NS will develop and share a plan of action for volunteer mobilization and activities to the coordinating body for feedback. ■ NS representatives from each district (3 per district) will participate in integrated trainings organized by the national or district MoH structures; ■ NS representatives will, in turn, train the +4,500 volunteers for the integrated campaign and for Hang Up and Keep Up activities post-distribution, which may not be effectively covered during the integrated training; ■ Social mobilization messages will be disseminated based on the national level and district level plans and messages developed and agreed upon in the social mobilization subcommittee and through the coordinating body; ■ The MoH will participate in and support training sessions and supervision of NS volunteer social mobilization activities; ■ NS field officers and/or branch health officers will maintain regular contact with the MoH DHMT responsibles, and will ensure regular activity reports are filed with both the MoH and the NS branch and HQ offices.

4. Logistics ■ The NS logistician will be an active member of the logistics sub-commission at national level, working closely in partnership with the MoH logistician and team identified;

Appendix 5 / Template for a Memorandum of Understanding //

85

■ The IFRC will provide a delegate to assist with preparations for the logistic elements of the integrated campaign, with a particular focus on the LLIN component; ■ The MoH and the NS will be jointly responsible for ensuring that the logistics chronogram of activities, specifically that related to movement of LLINs, will be adhered to; ■ The logistics team, led by the MoH and supported by the IFRC, will be responsible for submitting a budget to the NS/IFRC for elements related to transportation of nets; ■ District level logistics teams, composed of representatives from the DHMT and the NS district branches, with support from the national level logistics team, will be responsible for the district level planning of movement of LLINs from district centers to distribution points, including developing a budget for this activity; ■ The national logistics team will be responsible for the tendering process for a transportation company for the LLINs according to either NS or MOH policy (to be decided); ■ MoH and NS will, where possible, provide logistics support such as vehicles to the logistics team to facilitate planning and implementation of the logistics plan; ■ The NS and the MoH will assume joint responsibility for the distribution of the LLINs; NS volunteers will distribute the nets and will be supervised and monitored by joint teams of MoH personnel and NS field/programme officers.

5. Finance ■ The NS in collaboration with the IFRC will receive and administer finances for their social mobilization activities, and for the transportation of the LLINs, according to the agreement signed with the IFRC; ■ The IFRC will provide funds for social mobilization activities, logistics and the external evaluation according to approved budgets submitted by NS, the logistics delegate and the Centers for Disease Control respectively; ■ The NS will pay per diems to volunteers and others involved (e.g. logistics team members) according to NS volunteer and staff policies; ■ The MOH and the NS will determine the financial arrangements for the district level movement of LLINs and will submit a proposal on the management of district level funds to the Logistics Delegate/Program Manager of the CRC for approval.

6. Evaluation ■ Both parties (at national and district levels) agree to participate in the final evaluation of the project, to be conducted by the Centers for Disease Control, in (insert date). Protocols will be developed by the CDC for this evaluation.

7. Reporting a. District Level ■ The NS and the MOH will jointly submit a report at the end of the integrated child survival campaign that discusses processes, activities, problems encountered and lessons learned. b. National Level ■ A final report will be produced by the Ministry of Health. ■ A final report will be produced by the NS.

8. Final Dispositions ■ Any contentions regarding the implementation of the present agreement at national and district levels, and any disagreement or difference of interpretation or omitted subjects, will be solved in a friendly way and through consultation and negotiation. All changes to the agreed protocol will be agreed upon by all parties.

LLIN scale-up and hang-up programme

86

International Federation of Red Cross and Red Crescent Societies

The present agreement has been issued in two originals.

Anytown, the date 200-----

_____________________________ Ministry of Health

____________________________ Red Cross/Red Crescent

Appendix 6 / Example of chronogram for a mass LLIN distribution programme //

Appendix 6

87

Example of chronogram for a mass LLIN distribution programme Nigerian Red Cross Society 2008

Integrated planning: July 19th 2008 Activities Responsible Timeline National level April May June July Aug Sept Oct Nov Dec Jan

Comments/notes

Assessment visit CRCS, IFRC & NRCS to Cross River state NRCS finalise POA & budget with CRCS & IFRC NRCS sign PIA with CRCS Fortnight meeting with NMCP, NPHCDA and other stakeholders Weekly NRCS staff meeting – internal NRCS update on campaign progress National social mobilisation workshop NRCS, MoH & other stakeholders in Kaduna Follow up with Cross River Branch to identify supervisors and volunteers; ensure initial contact with ward, LGA and state health authorities Consolidate micro-plans (MoH) and branch information (NRCS) to match sites with volunteers and identify gaps for MoH Modification of training guide, curriculum and volunteer support tool, volunteer identification, e.g T Shirt Photocopy/reproduction of guide and supports, plan for their distribution to state/LGA/ward

NRCS, CRCS, IFRC NRCS, CRCS, IFRC NRCS, CRCS NRCS, MoH

5 day national training of Trainers/Supervisors; ensure cofacilitated by the MoH; develop schedule for training of volunteers; develop schedule for supervision of activities (pre, during and post campaign) NRCS NHQ staff participate in MoH training Handing over ceremony by CRCS, NRCS & IFRC Official launch of LLIN in Cross River State Monitoring and support visit from NHQ & Zone Participation in campaign activities

NRCS

Date depends on expert review committee recommendation

RBM

Marcy’s training to MoH

NRCS must submit minutes of meetings

NRCS, MoH NRCS

Update reports required

NRCS

National level consolidation of state micro-plans complete by Sept 26

NRCS/CRC

NRCS

NRCS/CRC NRCS NRCS

NRCS & State MoH Final report on campaign activities NRCS

NRCS will participate with 50 volunteers

LLIN scale-up and hang-up programme

88

International Federation of Red Cross and Red Crescent Societies

Integrated planning: July 19th 2008 Activities Responsible Timeline National level April May June July Aug Sept Oct Nov Dec Jan Cross River state branch NRCS

Comments/notes

BSS, BHC, MCC already recruited NRCS to submit reports of these meetings

NRCS, MoH NRCS

Dec 3-7 Dec 08

2 day Volunteer training and distribution of supports (activity forms, identification, etc.); volunteer workplan and management strategy; training co-facilitated by MoH Social mobilisation pre-campaign NRCS (community meetings, house-tohouse visits) Campaign launch at state level NRCS & State MoH Campaign implementation MoH & NRCS Post-campaign activities (hang-up) NRCS Post-campaign internal evaluation NRCS Final report on campaign activities from the LGAs/state

NRCS participates

2nd and 3rd week of Nov

Micro-planning workshops at MoH ward/LGA level that will provide critical information for planning re: numbers and locations of sites to be matched to volunteers

State microplans dueSept 5

NRCS & State MoH

According to MoH schedule

State/LGA level Cross River branch integrate with MoH & other stakeholders Recruitment of 39 supervisors and 900 volunteers Coordination meetings, including sub-groups for logistics and social mobilisation Community sensitisation meetings with authorities and local leaders Consolidate micro-plans (MoH) and branch information (NRCS) to match sites with volunteers and identify gaps for MoH

Appendix 7 / Example of logical framework for a mass LLIN distribution programme //

Appendix 7

89

Example of logical framework for a mass LLIN distribution programme Malawi Red Cross Society 2008

Objective 1

Increase community knowledge and awareness on malaria disease and its control.

Goal

To sustain a major reduction in the morbidity and mortality due to malaria and childhood vaccine preventable diseases through mobilizing Red Cross volunteer groups in Mwanza and Chiradzulu and Blantyre districts.

Expected result

Community members know how to prevent malaria and how to treat fevers and seek medical assistance when needed

Main activity

Distribute nets for HBC/CBCC clients in project areas (CZ 100 new HBC vol, 1000 CBCC9)

Expected outputs

Annual targets

Indicator

At least 6,000 6,000 nets The number nets of nets distributed distributed to the target groups

Community mobilization Mobilization for access to bed nets done

All HHs

Health education on malaria

75% of all # of HE villages activities, # of participants at community level.

Health education carried out

Establish drama groups Increased 28 groups for community awareness on mobilization malaria disease and its control

Reports of home visits available and analyzed.

At least 28 drama groups trained and performing

Estimat- Respon- Impleed costs sible menting person partners

various

Means of verification

Other factors/ assumptions or risks assumed

DPO

MRCS/ MoH IFRC

DPO report Registration proposal and NC reports

Availability of nets from other donors: - IFRC - MOH - others

DPO

Drama groups

Coaches reports

All drama groups trained

DPO

Drama groups HSAs/

volunteers reports

-Very well established vol. mgt system -work plans at district level available

DPO/NC

- Drama groups - MOH Health education teams

DPOs reports

All trainings done

NC -RC HQ

Effective dram groups trained

Conduct drama performances with malaria messages

Performance carried

3 perfor- # of drama mances performances per village per year

DPO

Drama groups

Monitor utilization of nets

Monitoring done

Awaits results of baseline

% of households with at least one ITN/LLTN

DPO

MAC/CDC Coaches/DPOs All volunteers reports trained on ITN project

Collaborate with health facilities and other stakeholders (take advantage of National re-impregnation week event)

Collaboration coordination /links strengthened

-

- # of clients referred to the health care facilities

NC

MoH, MAC

- NC reports - Invitations to such Volunteer meetings reports registrations for information

50,000

Number of IEC materials reprinted and distributed

NC

MoH, IFRC

NCs reports

Develop/source/reprint IEC materials and Distribute IEC developed or materials sourced

Funding availability

LLIN scale-up and hang-up programme

90

International Federation of Red Cross and Red Crescent Societies

Main activity

Expected outputs

Annual targets

Indicator

Estimat- Respon- Impleed costs sible menting person partners

Conduct home visits on Increased 1 visit per # of home malaria control knowledge HH every visits made by and treatment 3 months volunteers. of about Develop work malaria plans for vol.

Coaches/ MoH DPOs

Means of verification

Household registers and HSA reports

Other factors/ assumptions or risks assumed All volunteers trained are very active in program

Objective 4

Contribute to the reduction of malaria incidence in the three districts.

Goal

To sustain a major reduction in the morbidity and mortality due to malaria and childhood vaccine preventable diseases through mobilizing Red Cross volunteer groups in Mwanza, Chiradzulu and Blantyre districts.

Expected result

A minimum of >80% of children under five years and pregnant women who have access to and use either ITNs or LLINs.

Main activity

Expected outputs

Annual targets

Indicator

Estimat- Respon- Implementing ed costs sible person partners

Means of verification

Other factors/ assumptions or risks assumed

Village registers/ volunteer reports/ DPOs reports

DPo support to volunteers Collaboration with TBAs and HC

Number of women and children who visited HCs and gotten a net No. of HHs visted

Volunteers MoH DPO

All HHs BCC fully understood Adequate malaria procedures in place at HH level 6,000 Nets distributed

Number of visits per HHs with at least one ITN/LLTN -Three drama per village per year performance Number of nets distributed

MAC/MoH DPO/DHO DPO /MAC Volunteers

DPO

MoH

M&E reports

Volunteers very active

HHs hanging 6,000 and using nets properly HH visits

Number of nets hanging and properly used in HHs -Number of HHs with at least one ITN/LLTN hanging -Minimum of 3 visits per HH per year % of 80% of pregnant women attending antenatal clinics receive IPT and TT vaccinations. Objective 3: Contribute to the reduction in mortality and morbidity of vaccine preventable diseases in pregnant women and children under the age of one. Objective 5: To follow up re-treatment of ITNs at the HH and community level. Objective 6: To strengthen the relationship with all partners at national and community level. Objective 7: To maintain and link existing programmes to the ITN project. Objective 8: Establish a well-functioning volunteer management system as defined in ARCHI 2010. Objective 9: Institutional strengthening of MRCS to implement and manage the malaria programme (ITN project).

LLIN scale-up and hang-up programme

92

International Federation of Red Cross and Red Crescent Societies

Appendix 8

No

Name of settlements

Unload & offload (district and distribution point)

Example of a district micro-planning template for follow-up measles campaign in Liberia in 2007 (spreadsheet) Total pop.

Vehicles required

Target pop. (6-59 months)

Vehicles available

Nets required

Vehicle gap and cost for rental

Km of travel

Bales required

Fuel

Warehouse storage available Yes/No

Warehouse security available Yes/No

Conveyors or labourers

Distributors

Nets required = target population/1.3 + 15% Bales required = number of nets/100 Warehouse/Storage: location and adequate space Warehouse security: staff necessary Unload and offload: number of volunteers required Number of vehicles required to move nets from district centre to vaccination sites Number of vehicles available: government, NGO etc. Vehicle gap: required versus available Km of travel: supply circuit to deliver nets (as many drop-off points as possible per trip) Fuel: requirements for moving nets country to district to distribution points Conveyors or labourers: determine if additional labour required to move nets to remote/inaccessible areas Distributors: community health workers identified, 2 per vaccination site

Appendix 9 / Key considerations for district level micro-planning for nets //

Appendix 9

93

Key considerations for district level micro-planning for nets, examples of waybill, stock book and distribution log District Level Micro-Planning for Nets ■

■ ■ ■ ■

■

■

Because of their knowledge of their territory and their experience in micro-planning vaccination campaigns, district health authorities will be requested to develop a plan and a budget for the transport of the nets from the district depots to the distribution points DHMT planners should work closely with local partners to benefit from existing infrastructure (e.g. warehousing and security) and logistic support (e.g. KRCS, PSI, etc.) Micro-logistics planning should include transport, handling (loading/off-loading), storage, security and control Waybills, warehouse journals and stock books should be prepared to monitor and control the movement of the nets Waybills should be used to control the number of bales loaded and offloaded; one waybill should be issued for each drop-off point- if a truck is offloading at more than one point, a waybill should be issued for each drop off site Warehouse journals and stock books should record the quantities of nets received from the port (Mombasa) and the number of bales shipped out to the various distribution points; these journals will keep track of the balance of stock in the warehouse DHMT will be responsible for producing a final logistics report detailing the management of the nets

Logistics Planning- Micro-Log Districts are requested to develop a logistics plan outlining the following:

1. Transport a. b. c. d.

How many distribution or drop off points will be reached? What is the total distance of the ‘supply circuit’? How many vehicles are required? What size per circuit? Are vehicles available within the district? If not, where can they be sourced and at what cost? e. How many days are required to get the nets from the depot to the distribution point?

2. Handling, Storage and Security a. Where can nets be stored at district level? How close are these locations to the distribution point? How many vehicles are required to move the nets from storage to distribution point for the days of the campaign? b. How will security for the nets be ensured?

3. Control of Operation a. Waybills, warehouse journals and stock books should be used to monitor movement of nets

Budget Planning- Micro-Log Districts should develop a budget based on: ■ Costs of fuel ■ Costs for drivers ■ Costs for convoyers (people who will travel with trucks to ensure nets leaving and nets arriving are equal numbers) ■ Costs for security (e.g. guards) ■ Costs for renting warehouse space

LLIN scale-up and hang-up programme

94

International Federation of Red Cross and Red Crescent Societies

An example of the waybill and the stock book is attached. A template for micro-planning is also attached.

WAYBILL

Logo MoH / CVM / CRC ???

No.

(Pre-numbered)

Date ______________________ Sender ___________________________

Recipient ___________________________

District ___________________________

District _____________________________

Mode of Transport _________________________

Item

No.

CTN

and

No. _________________________

Donor

Quantity

Unit

Packaging

1 2 3 4 5 6 7

Comments / observations

For delivery

(condition of merchandise upon delivery: missing / damaged goods etc)

For receiving

(convoyer)

(MoH authority)

Name ________________________________________

Name _________________________________________

Signature _____________________ Date ___________

Signature _____________________ Date ____________

Signature of sender ____________________________________________________ Date _____________________ White: Recipient

Blue: Transporter

Green: Logistics

Yellow: Sender

Appendix 9 / Key considerations for district level micro-planning for nets //

Logo ??

Mozambique Ministry of Health CVM CRC

Warehouse journal / Stock book District

# ref.

Date

Distribution Point

Origin

No LLINs

Waybill Number

Destination

No Bales

95

No People

W-house Loc

Province of Number of Truck plate Number Number of Stock (nets) bales on bales number received bales sent Stock (bales) (bales x 40) Waybill

Km Travel

No Vehicles Req

Fuel

Per diem drivers

On and Off load

W-house security

Per diem log team

Remarks

Total

Micro-planning template Column 1: Column 2: Column 3: Column 4: Column 5: Column 6: Column 7: Column 8: Column 9: Column 10: Column 11: Column 12: Column 13:

Distribution points in each of the districts Number of LLINs per distribution point Number of bales per distribution point Number of people required to accompany nets from district depot to distribution point (waybills and counting) Warehousing available in close proximity to distribution points; if necessary to pay rental fees, add column Distance from district depot to distribution point (should be a circuit, so a number of points in one trip) Number of vehicles required to move the total number of nets from district depot to distribution site Amount of fuel for transport routes to deliver nets from district depots to distribution sites Per diem for drivers to deliver nets Cost for on and off loading of nets at distribution points Cost for guards for warehouse security Logistics team incentive Total cost

LLIN scale-up and hang-up programme

96

International Federation of Red Cross and Red Crescent Societies

Appendix 10 Example of macroquantification: requirement for LLINs Serial, 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

State

Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River Cross River

LGA name

Abi Akamkpa Akpabuyo Bakassi Bekwarra Biase Boki Calabar Municipal Calabar South Etung Ikom Obanliku Obubra Obudu Odukpani Ogoja Yakurr Yala

Totals

Total POP Total POP Total POP Total POP (2008) (2006) (2007) U5 (20%)

144,802 151,125 271,395 32,385 105,822 169,183 186,041 179,392 191,630 80,196 162,383 110,324 172,444 160,106 192,444 171,901 196,450 210,843 2,888,866

149,436 155,961 280,080 33,421 109,208 174,597 191,994 185,133 197,762 82,762 167,579 113,854 177,962 165,229 198,602 177,402 202,736 217,590 2,981,310

Yearly increase 3.2 % 154,218 160,952 289,042 34,491 112,703 180,184 198,138 191,057 204,091 85,411 172,942 117,498 183,657 170,517 204,957 183,079 209,224 224,553 3,076,712

30,844 32,190 57,808 6,898 22,541 36,037 39,628 38,211 40,818 17,082 34,588 23,500 36,731 34,103 40,991 36,616 41,845 44,911 615,342

LLIN w/20% BUFFER 33,928 35,409 63,589 7,588 24,795 39,640 43,590 42,032 44,900 18,790 38,047 25,849 40,405 37,514 45,091 40,277 46,029 49,402 676,877

BALES 100xnets

339 354 636 76 248 396 436 420 449 188 380 258 404 375 451 403 460 494 6,769

LLIN delivery

5% 5% 9% 1% 4% 6% 6% 6% 7% 3% 6% 4% 6% 6% 7% 6% 7% 7% 100 %

Appendix 11 / Site set up PowerPoint presentation //

97

Appendix 11 Site set up PowerPoint presentation* Vaccination Post Strategies Q

Fixed posts – Predominant tyoe of site – Typically located in health facility (government, private, mission, etc)

Site Set Up Q

Temporary fixed posts – Post created to ensure high covered – Post remains in same place and open throughout campaign

Sierra Leone National Integrated Child Survival Campaign Q

Mobile posts – Outreach to hard to reach areas with poor HC access – Team visits a place, vaccinates all children and moves to new location

Elements of Post Q Q Q Q Q Q Q Q

Waiting and crowd controm area Registration and screening Mebendazole administration Vitamin A supplementation Measles vacination LLIN distribution Marling and tallying LLIN sensitization

Furniture and Equipment Q Q Q Q Q

5 tables and 5 chairs Other seating (benches, mats for caretakers and children) Containers with water, basin, soap and cup (handwashing and MBZ) Banners and posters to identify site Writing materials for marking campaign cards

What makes a good post?

Staffing of Site Q

Sites have at least four staff:

– 1 vaccinator (health worker who also functions as team leader) – Registrar/Screener – MBZ and vitamin A administraator – LLIN distributor Q Additional staff and volunteers will be used for crowd control (both at the entry and the exit points)

Q Q Q Q Q Q Q

Adequate shade/shelter from rain Efficient client flow (ideally one-way) Sufficient staff workers ans volunteers Identification with banner/poster LLIN demonstration (correct) Water availble with MBZ administration Sansitization area for LLIN use

Where should a post be located? Q Q

Open area to allow apace for crowds and organization of beneficiaries

Easaly accessible to population Site familiar to population (e.g. used for NIDs or other health activities) Q Building, veranda or with shade Q Clean envirronment, latrine available Q Safe for health worker and beneficiaries Q

Proposed Site Organization Filter for order Entry

Registration MBZ/Vit A Measies Where adequate numbers of volunteers, LLIN hanging sansittization post-distribution

*The full PowerPoint presentation can be found on the accompanying CD.

LLINs Exit

LLIN scale-up and hang-up programme

98

International Federation of Red Cross and Red Crescent Societies

Crowd Control Q Q Q Q Q

Crowd Control2

Strategies differ for urban and rural Begins as far from tha site as possible Important to protect both health workers and beneficiaries Risks of injury and death where crowds not controlled (pushing, children failing, etc) Adequate 'staff' (health worker/volunteer) to ensure effective control wothout putting 'staff' at risk

Q Q Q

Q

Urban areas always problematic Different local solutions exist Planning for crowds starts before the campaign starts… problems cannot easely be solved on the spot when the crowd is already there Supervisors should have strategy for handling situations thata are non-controllable without significant risk who do you call? What do you do? (e.g. closing post , calling authorities, etc)

Registration and Screening Q Q Q

Q

Campaign Card

Caretakers welcomed and thanked for bringing children for vaccination Children assigned interventions by age and given a campaign card Campaign cards must be filled out correctly at the registration table to ensure that children receive all interventions for whitch they are eligible Mothers must be directed to their first intervention table

Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Measies 9-59 months

Vitamin A 6-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Child under 6 Months

Child 6 to 12 Months

Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Measies 9-59 months

Vitamin A 6-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Measies 9-59 months

Child over 12 Months Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Vitamin A 6-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Potential Challenges with Registration Q Q

Measies 9-59 months

Vitamin A 6-59 months

Q

How is a situation where a child has no card and the age is unknown dealt with? How do you explain to caretakers that not all children will receive a net where there are more than 2 childrenwith the mother? How do you mark the card if a child is not receiving a net?

Appendix 11 / Site set up PowerPoint presentation //

99

Child over 12 Months Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Vitamin A and Mebendazole Administration Q Q Q

Measies 9-59 months

Vitamin A 6-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Q

Measles Vaccination

Must be administered prior to measles vaccine to ensure ingested properly Inform caretakers that children need vitamin A supplementation every 6 months Inform caretakers that children may have worms in stool in days post-campaign Can be difficult to administer to the youngest eligible cheldren water should be available to assist children with swallowong

LLIN Distribution Q

Nets should be given to caretakers with the packaging torn open to deter resale – Nets should NOT be remove from the packaging

Q Q

Marking TIP OF THUMB NAIL

BASE OF LEFT THUMB NAIL

Caretakers and children should be marked on the left thumb Marking must be done properly to ensure that mothers do not put children at risk of AEFI through re-vaccination of children to receive more nets Ink needs to dry 15-20 seconds to ensure duration on nail The cap should be put back on the marker immediately to prevent drying out of ink

End Result ?

Integrated Package for Improved Child Survival!

Distributors should emphasize thet LLINs are for children under five Caretakers and children will be marked with indelible ink on the thumb

Exiting Site Q Q

Mothers and caratakers should exit the site once all interventions receaived to avoid crowding Where possible, volunteers should sensitize mothers as they exit the site – Sensitization areas can be set up at a distance from the last table (LLIN distribution)

LLIN scale-up and hang-up programme

100

International Federation of Red Cross and Red Crescent Societies

Appendix 12 Example of instructions for the proper marking of mothers’ and children’s fingers during a campaign Instructions for the proper use of the indelible markers.

1. 2. 3. 4. 5. 6. 7.

Uncork the marker when ready to mark the child’s and mother’s little left finger. Apply a single line from the bottom to the top of the nail of the left small finger. Recap the marker immediately after use. The ink mark should not be rubbed off immediately (leave for at least 30 seconds) The marker is sufficient for marking at least 500 children if properly used. Ideally keep the marker horizontally in a cool, dry and dark place when not in use. These markers are the property of the ministry of health. Return them.

Appendix 13 / Example of spreadsheet for estimating storage requirements //

101

Appendix 13 Example of spreadsheet for estimating storage requirements LGA locations

Abi Akamkpa Akpabuyo Bakassi Bekwarra Biase Boki Calabar Municipal Calabar South Etung Ikom Obanliku Obubra Obudu Odukpani Ogoja Yakurr Yala

Popula- Pop. U-5 Plus 10% No of tion 2008 20% LLINS bales x 100

Tonnage (kgs)

154,218 160.952 289.042 34,491 112,703 180,184 198,138 191,057 204,091 85,411 172,942 117,498 183,657 170,517 204,957 183,079 209,224 224,553

30,844 32,190 57,808 6,898 22,541 36,037 39,628 38,211 40,818 17,082 34,588 23,500 36,731 34,103 40,991 36,616 41,845 44,911

33,928 35,409 63,589 7,588 24,795 39,640 43,590 42,033 44,900 18,790 38,047 25,850 40,405 37,514 45,091 40,277 46,029 49,402

339 354 636 76 248 396 436 420 449 188 380 258 404 375 451 403 460 494

16,625 17,351 31,159 3,718 12,149 19,424 21,359 20,596 22,001 9,207 18,643 12,666 19,798 18,382 22,094 19,736 22,554 24,207

Totals 3,076,714

615,343

676,877

6,769

331,670

Cbm per bale Total number of bales Bale weight (kg) LLINs order

Volume (m3) 66.499 69.403 124.635 14.873 48.598 77.695 85.437 82.384 88.004 36.829 74.573 50.665 79.193 73.527 88.377 78.944 90.217 96.827

H=2

33.249 34.701 62.317 7.436 24.299 38.848 42.719 41.192 44.002 18.415 37.286 25.333 39.596 36.763 44.189 39.472 45.109 48.414

SQRT

6.919 7.069 9.473 3.272 5.915 7.479 7.843 7.702 7.960 5,149 7.328 6.040 7.551 7.276 7.977 7.539 8.060 8.350

Storage % of (m2) LLINs 47.9 50.0 89.7 10.7 35.0 55.9 61.5 59.3 63.4 26.5 53.7 36.5 57.0 52.9 63.6 56.8 65.0 69.7

5.01% 5.23% 9.39% 1.12% 3.66% 5.86% 6.44% 6.21% 6.63% 2.78% 5.62% 3.82% 5.97% 5.54% 6.66% 5.95% 6.80% 7.30%

955.2 100%

0.196 Bale size (77cm x 67cm x 38cm) 6,769 49 676,877 (190 x 180 x 150cm PermaNet-100% polyester 75dl .30gm/sqm-White)

LLIN scale-up and hang-up programme

102

International Federation of Red Cross and Red Crescent Societies

Appendix 14 Selection of customs clearance agent: flowchart and notes Customs clearance Activity

Who?

Initial contact

NS

Detailed contact

NS

Review all contacts

Sub-commission Ministry of

Select contacts to visit

Members of sub-commission

Send out requests for quotations to contacts

Sub-commission decision

Comparative bidding process

Sub-commission decision

Award contract

Sub-commission decision

The following information is designed to provide a clear explanation of the flow chart for acquiring a customs clearance agent. Initiatives and suggestions for improving this process are welcome.

Initial contact: (1) ■ ■ ■

Research the various local companies. Obtain the name, location and telephone number of the contact person. Confirm whether the company carries out humanitarian custom clearances in the country and whether their services are available for contracting.

Detailed contact: (2) ■

■

Telephone contact is made with the customs clearing agent and more information is requested, such as which humanitarian organizations they carried out clearance for, their availability and their expertise in dealing with large shipments. This information is charted in detail on a master list created by the National Society logistician.

Review all contacts: (3) ■ ■

Once stage 2 has been completed, all information is presented to the logistics sub-commission. Discussion on possible companies takes place with a decision on which ones will be visited.

Appendix 14 / Selection of customs clearance agent: flowchart and notes //

■ ■

103

A visit team is agreed to which consists of at least one member from all partner groups, for example, ministry of health, the National Society and other partners. The schedule is arranged and agreed.

Visit checklist ■ ■ ■ ■ ■ ■

Is the clearance agent able to handle large shipments or loads? What experience does the company have in dealing with large shipments, such as LLINs? How big is the company and how many staff does it employ? Is it located in the operating country? How much notice does the company require (in advance of the shipment) in order to ensure a problem-free clearance in the country? Would there be any extra costs incurred as a result of delays in the LLIN clearance process, if known? Will they negotiate the agent’s fee if they are awarded the shipment clearance contract?

Request for quotations: (4) ■ ■ ■ ■ ■

After the visit at stage 3 has been completed, the sub-commission will decide on who should receive an offer of a request for quotation (RFQ). Remember, the cheapest customs clearance agent is not always the best option. Due diligence is required for good results. The RFQ will have to be issued, providing all necessary information for the company to have a fair chance to compete for the contract. This RFQ must include a return date for submission, with all returns to be submitted in sealed envelopes to the logistics sub-commission. No returns will be opened until the logistics sub-commission meeting. Late submissions will not be considered out of fairness to other bidders, and this condition will be included in the RFQ so that all bidders are aware of the deadline.

Comparative bidding process: (5) ■ ■

Using comparative bidding sheets, the sub-commission will examine all bids and decide the winner. It is normal to have only one customs clearance agent handling the LLIN shipment. Once selected, the successful company will be notified verbally and a visit should take place to continue negotiations on getting a better deal in terms of cost.

Award contract: (6) ■ ■

Once the best price has been obtained and it has been verified that the cost is within the budget, a formal letter will be sent to the successful company. The formal contract is prepared and is signed by the National Society and the successful company, detailing all points agreed.

This flow chart is designed to help a National Society find a suitable customs clearance agent. It is important to carry out the process in a transparent and honest way to avoid receiving complaints from organizations who may claim the process was unfair, flawed or dishonest. All used comparative bidding documentation should be kept for historical and tracking purposes.

LLIN scale-up and hang-up programme

104

International Federation of Red Cross and Red Crescent Societies

Appendix 15 Selection of transport operators: flowchart and notes Transport Activity

Who?

Initial contact

NS

Detailed contact

NS

Review all contacts

Sub-commission Ministry of

Select contacts to visit

Members of sub-commission

Send out requests for quotations to contacts

Sub-commission decision

Comparative bidding process

Sub-commission decision

Award contract

Sub-commission decision

The following information is designed to provide a clear explanation of the flow chart for acquiring transport operators. Initiatives and suggestions for improving this process are welcome.

Initial contact: (1) ■ ■ ■

Search the town and local area for suitable transport companies. Obtain the name, location and telephone number of the contact person. Confirm whether they offer long-haul services country-wide and whether they are available for contracting.

Detailed contact: (2) ■

■

Telephone contact is made with the transport operator and more details are requested such as inventory size and type, initial cost, number of vehicles available during distribution period, condition of fleet. This information is charted in detail on a master list by the National Society logistician.

Review all contacts: (3) ■ ■

Once stage 2 has been completed, all information is presented to the logistics sub-commission. Discussion on possible companies takes place with a decision on which ones will be visited.

Appendix 15 / Selection of transport operators: flowchart and notes //

■ ■

105

A visit team is agreed to which must consist of at least one member from all partner groups, for example, ministry of health, the National Society and other partners. The schedule is arranged and agreed.

Visit checklist ■ ■ ■ ■ ■ ■

Is the transport operator able to handle large loads? What side of town is it on, will there be problems moving in and out of town during distribution? What is the physical condition of the fleet? What is the condition of the trailers, the security of doors, low-beds, tarpaulins for covering loads, tie-down rigging and load security? Would vehicles be available if the company is awarded the contract to transport large amounts of LLINs? What are the hiring conditions and costs?

Request for quotations: (4) ■ ■ ■ ■ ■

After the visit at stage 3 has been completed, the logistics sub-commission will decide on who should receive an offer of a request for quotation (RFQ). Remember, the cheapest transport operator is not always the best option. Due diligence is required for good results. The RFQ will have to be issued, providing all necessary information for the company to have a fair chance to compete for the contract. This RFQ must include a return date for submission, with all returns to be submitted in sealed envelopes to the logistics sub-commission. No returns will be opened until the logistics sub-commission meeting. Late submissions will not be considered out of fairness to other bidders, and this condition will be included in the RFQ so that all bidders are aware of the deadline.

Comparative bidding process: (5) ■

■

Using comparative bidding sheets, the logistics sub-commission will examine all bids and decide the winner. It is unlikely that one transporter will have the capacity to move all the LLINs. Therefore, three to five companies may be selected or needed to complete the movement depending on the number of LLINs. Once selected, the successful company will be notified verbally and a visit should take place to continue negotiations on getting a better deal in terms of cost.

Award contract: (6) ■ ■

Once the best price and transport operators have been obtained and it has been verified that the cost is within the budget, a formal letter will be sent to the successful company(s). The formal contract is prepared and is signed by the National Society and the successful company(s), detailing all points agreed.

This flow chart is designed to help a National Society find suitable transport operators. It is important to carry out the process in a transparent and honest way to avoid receiving complaints from organizations who may claim the process was unfair, flawed or dishonest. All used comparative bidding documentation should be kept for historical and tracking purposes.

LLIN scale-up and hang-up programme

106

International Federation of Red Cross and Red Crescent Societies

Appendix 16 Example of conveyor training agenda Conveyor Training Agenda 1. Overview of role ■

Conveyors have a critically important role in the overall distribution of LLITNs; overseeing the delivery of nets from central warehousing to county/district storage facilities. In accompanying deliveries conveyors facilitate prompt and efficient delivery to proper destinations and ensure deliveries are received and signed for by the proper receiving authority.

2. Breakdown of duties and responsibilities ■

■ ■

■

Assist in overseeing the loading of LLITNs: ❏ Identify self to logistics coordinator and driver. ❏ Count bales being loaded and ensure they are secured. ❏ Sign waybill. Accompany the delivery, checking the load at all times. Assist in overseeing the unloading of LLITNs: ❏ Identify self to receiver. ❏ Count bales being unloaded. ❏ Ensure waybill is signed by receiver and returned to logistics coordinator. Act as contact point for delivery: ❏ Communicate any problems directly to logistics coordinator and/or contact person at destination.

3. Familiarization of waybill ■ ■

Where to write quantities and where to sign. Which copies to deliver, and which to retain.

4. Overview of routes and Per Diem amounts ■ ■

Provide copy of dispatch plan, assign routes Have conveyers sign agreement with per diem rate

Appendix 17 / Selection of warehousing facilities: flowchart and notes //

107

Appendix 17 Selection of warehousing facilities: flowchart and notes Warehousing Activity

Who?

Initial contact

NS

Detailed contact

NS

Review all contacts

Sub-commission Ministry of

Select contacts to visit

Members of sub-commission

Send out requests for quotations to contacts

Sub-commission decision

Comparative bidding process

Sub-commission decision

Award contract

Sub-commission decision

The following information is designed to provide a clear explanation of the flow chart for acquiring transport operators. Initiatives and suggestions for improving this process are welcome.

Initial contact: (1) ■ ■ ■

Search the town and local area for suitable transport companies. Obtain the name, location and telephone number of the contact person. Confirm whether they offer long-haul services country-wide and whether they are available for contracting.

Detailed contact: (2) ■

■

Telephone contact is made with the transport operator and more details are requested such as inventory size and type, initial cost, number of vehicles available during distribution period, condition of fleet. This information is charted in detail on a master list by the National Society logistician.

Review all contacts: (3) ■ ■

Once stage 2 has been completed, all information is presented to the logistics sub-commission. Discussion on possible companies takes place with a decision on which ones will be visited.

LLIN scale-up and hang-up programme

108

International Federation of Red Cross and Red Crescent Societies

■ ■

A visit team is agreed to which must consist of at least one member from all partner groups, for example, ministry of health, the National Society and other partners. The schedule is arranged and agreed.

Visit checklist ■ ■ ■ ■ ■ ■

Is the transport operator able to handle large loads? What side of town is it on, will there be problems moving in and out of town during distribution? What is the physical condition of the fleet? What is the condition of the trailers, the security of doors, low-beds, tarpaulins for covering loads, tie-down rigging and load security? Would vehicles be available if the company is awarded the contract to transport large amounts of LLINs? What are the hiring conditions and costs?

Request for quotations: (4) ■ ■ ■ ■ ■

After the visit at stage 3 has been completed, the logistics sub-commission will decide on who should receive an offer of a request for quotation (RFQ). Remember, the cheapest transport operator is not always the best option. Due diligence is required for good results. The RFQ will have to be issued, providing all necessary information for the company to have a fair chance to compete for the contract. This RFQ must include a return date for submission, with all returns to be submitted in sealed envelopes to the logistics sub-commission. No returns will be opened until the logistics sub-commission meeting. Late submissions will not be considered out of fairness to other bidders, and this condition will be included in the RFQ so that all bidders are aware of the deadline.

Comparative bidding process: (5) ■

■

Using comparative bidding sheets, the logistics sub-commission will examine all bids and decide the winner. It is unlikely that one transporter will have the capacity to move all the LLINs. Therefore, three to five companies may be selected or needed to complete the movement depending on the number of LLINs. Once selected, the successful company will be notified verbally and a visit should take place to continue negotiations on getting a better deal in terms of cost.

Award contract: (6) ■ ■

Once the best price and transport operators have been obtained and it has been verified that the cost is within the budget, a formal letter will be sent to the successful company(s). The formal contract is prepared and is signed by the National Society and the successful company(s), detailing all points agreed.

This flow chart is designed to help a National Society find suitable transport operators. It is important to carry out the process in a transparent and honest way to avoid receiving complaints from organizations who may claim the process was unfair, flawed or dishonest. All used comparative bidding documentation should be kept for historical and tracking purposes.

Appendix 18 / Example of a budget template //

109

Volunteer identification 1 Participation in micro-planning National level Transport and meeting costs Communications

1.1

Sub-total 1.1 Regional level Transport to districts Accommodation Per diem Communications

1.2

2

Headquarters, regional and/or district level

One or more people may be participating in various committees Phonecards One or more regional coordinators may be following up on district plans 20 litres for each 100 kilometres, or public transport Accommodation, if required Daily rate Phonecards

Sub-total 1.2 District level Local meetings Communications

1.3

Local transport, if required Phonecards

Sub-total 1.3 Sub-total 1 Volunteer identification National level Accommodation for volunteer coordinator Per diem Transport Driver’s accommodation Driver’s per diem Communications

Depending on the number of regions/districts, and the distances involved Daily allowance Fuel – 20 litres for 100 kilometres

Phonecards for coordinator and driver

Regional level Accommodation Per diem Communications District level Transport

This would be a member of the district or local committee

Per diem Communications

Sub-total 2 Social mobilization 3 Supervisor training: HQ/region and district Training room Stationery Accommodation

One course of X days – total X participants/two facilitators Training of trainers Pens, paper, flipcharts, markers, photocopying, manual, etc.

day per person night

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Notes

Quantity

Description

Unit

Appendix 18 Example of a budget template

LLIN scale-up and hang-up programme

110

Food for participants (tea x 2, lunch x 1) Transport for participants

day return trip day litres

Per diem for 2 facilitators Transport for facilitators

4

Sub-total 3 Training – XXX volunteers Course of X days, covering before, during and after Stationery for training Photocopying Training room

the campaign Pens, paper and rain-proof folders for volunteers Volunteer supports The number of training sessions multiplied by the number of trainers multiplied by the number of days

Food for volunteers Transport for facilitators Per diem for facilitators Transport for participants

5

Sub-total 4 Supervision visits Headquarters level Per diem to field Accommodation Transport costs (fuel/oil)

X trips of x days

Vehicle maintenance

Lump sum Monthly phonecard subsidy for malaria officer Month/ wk The number of participants multiplied by the number Units of days

Communications Meetings

5.1

X litres multiplied by price (generally 20 litres per 100 kilometres) Maximum of seven trips

Sub-total HQ Regional level Per diem Accommodation Transport costs (fuel) Vehicle maintenance

X trips of X days

Communications

5.2

Day Night Litres Lump sum Month

Sub-total regions District level Field officer’s/supervisor’s per diem Transport subsidy- trainer, coach Transport costs (fuel) Communications

6

Day Night Litres

Day Day Litres Month

Sub-total districts Sub-total 5 Volunteer costs Incentives for XXX volunteers Volunteer identification

Sub-total 6

X volunteers paid X days pre, y days post, z days campaign (x+y+z) T-shirts or bibs, or other means of identification

Day Unit

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Notes

Quantity

Description

Unit

International Federation of Red Cross and Red Crescent Societies

Appendix 18 / Example of a budget template //

Social mobilization administration Desktop and printerfor social mobilization team Stationery and photocopying for malaria RCRC team Communications for malaria RCRC team Salary for malaria project assistant

Month

Sub-total 7 Communications 8 Media and public relations Media visits Vehicle rental Accommodation Fuel Per diem Refreshments

8.1

Sub-total 8.2 Reception – handover Food Drinks Invitations Entertainment Decorations

8.3

Sub-total 8.3 Public relations and print material Copies of briefing materials Folders Business cards Radio jingles Cameraman Photographer Film and CDs Photos and posters Newsletters

8.4

For visits with journalists For visiting journalists and/or media For site visits For visiting media Press meeting

Sub-total 8.1 Field visits Accommodation Per diem Transport (local) Transport (local rental) Fuel (rental) Phonecards Driver’s accommodation Driver’s per diem Vehicle maintenance

8.2

Sub-total 8.4 Communications total

Visits with local journalists to field sites

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Quantity

Unit

Notes

Description

7

111

LLIN scale-up and hang-up programme

112

9

Logistics Port costs and customs clearance Delivery order (container deposit) Demurrage costs (estimated) Scanning containers Scanning transport vehicles Port storage Handling Container inspection Insurance Administrative and other documentation charges Container transportation Clearing and forwarding charges

10

Refunded less demurrage charges deposit 60% of deposit Fixed price Fixed price Space that our container takes up in the port area Lifting containers etc. Fixed price Port insurance per container Documentation of shipment Movement out of the port 15% of the total cost

Sub-total 9 Coordination and handling Warehousing in Freetown Warehouse security Logistics team (during dispatch operation) Fuel (for local trips) Offloading containers and loading trucks Communications

Rental Security guards and equipment, if required X people for X days 20 litres per 100 kilometres

Phonecards for X persons over X days

Sub-total 10 Logistics team training for warehouse/dispatching

11 Axe 1 Accommodation

Transport Food Hall rental (2 days) Facilitator’s per diem (2 days) Driver’s per diem (2 days) Stationery

11.1 Sub-total 11.1 Axe 2 Accommodation Transport Food Hall rental (2 days) Facilitator’s per diem Driver’s per diem Stationery

11.2 Sub-total 11.2 Urban Facilitator’s transport Stationery Hall rental (2 days)

11.3

Sub-total 11.3 Sub-total 11

Trainers and driver

Flat rate Per diem for local facilitators, if required To facilitate workshop activities

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Notes

Quantity

Description

Unit

International Federation of Red Cross and Red Crescent Societies

Appendix 18 / Example of a budget template //

12 Conveying Conveyor’s training transport support Conveyor’s lunch during training Training facilities Conveyor’s per diem and travel costs Conveyor’s communications Offloading trucks in districts

Transport subsidy for training days Lunch or per diem Flat rate One conveyor per truck. Each trip takes 2-3 days or more One phonecard per conveyor Often included in the transport port districts

Sub-total 12 13 Transport from port to district Route 1

Tender usually required, including all transport costs, tolls, driver costs, insurance and, if possible, offloading

Route 2 Route 3 etc. Forecasted projection Sub-total 13 14 Management & admin. tools Printing stock books, warehouse journals, waybills Photocopying Communications Administrative support for districts

Flat rate Flat rate per month Phonecards for head of logistics and assistant If required, flat rate

Sub-total 14 15 Planning and supervision missions Logistics person’s accommodation Logistics person’s per diem Ministry of health logistics accomm. Ministry of health logistics per diem Driver’s accommodation Driver’s per diem Fuel Vehicle maintenance Communications

For minor repairs during mission – flat rate 4 persons x (1,000 units) x 4 missions

Sub-total 15 16 Transport from districts to distribution points Budget allocation

16.1

Allocation can be per bale or per net. The amount includes loading and offloading, transport, security and warehousing, if required. Often the responsibility of the district medical officer.

Sub-total 16.1 Contribution to regions/districts Can be actual or flat rate per district for per diem, for supervision fuel and accommodation, if required

Sub-total 16.2 Sub-total 16

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Quantity

Notes

Unit

Description

113

LLIN scale-up and hang-up programme

114

17 Vehicle support Vehicle leasing Third party insurance, registration and port costs Drivers’ salaries Maintenance and repair Fuel

Sub-total 17 Logistics total

Total budget Budget (1-17) Management & admin costs (4-6%) Bank charges (1%) Grand total

Leasing, if required, for the head of logistics during the distribution period

Comments

Control

Cost in local currency Costs in CHF or US$

Unit price

Notes

Quantity

Description

Unit

International Federation of Red Cross and Red Crescent Societies

Appendix 19 / Example of training manual for supervisors and volunteers //

115

Appendix 19 Nigerian Red Cross Society – Guide for training of supervisors and volunteers Unit 1

Social Mobilization What is social mobilization? Social mobilization involves planned actions and processes to reach, influence, and involve all relevant segments of society from the national to the community level, in order to create an enabling environment and effect positive behaviour and social change.

What is IEC? IEC is the acronym for Information, Education & Communication. IEC comprises a range of approaches, activities and outputs to raise awareness and promote positive action. Information: what is the intervention, who is being targeted, where can the intervention be received? Education: why is the intervention important to my child’s health? Communication: what are the important messages that must be given to the population?

What is BCC? Behavior change communication (BCC) is part of an integrated, multilevel, interactive process with communities aimed at developing tailored messages and approaches using a variety of communication channels. BCC aims to foster positive behavior; promote and sustain individual, community, and societal behavior change; and maintain appropriate behavior. BCC can: ■ Increase knowledge ■ Stimulate community dialogue ■ Promote essential attitude and behaviour change ■ Create demand for information and services ■ Promote services for prevention, care and support BCC is especially important in the case of immunization and LLINs. It is easy to distribute nets and provide vaccine to people to ensure that there is high coverage. People must change or modify their traditional behaviors and utilize routine immunization services and LLINs if they are to have an impact on overall health.

What techniques can be used for social mobilization? ■ ■ ■ ■ ■ ■

Community meetings and focus group discussions Interpersonal communications, such as household visits Drama, stories and songs for passing key messages Traditional entertainment Radio, television and print media Leaflets, posters, banners

What locations are appropriate for social mobilization? ■ ■

Religious structures / gatherings Schools

LLIN scale-up and hang-up programme

116

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■ ■

Market places Public gatherings and community meetings Water points Ceremonies Houses/homes

Who is social mobilization targeted at? ■ ■ ■ ■

Mothers, fathers and caregivers of children Religious, traditional and political opinion leaders Teachers and school children General public

Key messages about the integrated measles campaign 1. Mothers should bring all children 0-59 months to the closest vaccination post from 8th to 12th December 2008. 2. Children of eligible ages will receive: a. Measles vaccination (9-59 months) b. Vitamin A supplementation (6-59 months) c. OPV (0-59 months) d. LLIN (0-59 months) 3. All of the campaign interventions are free of charge. Key messages, as well as background information regarding the interventions, can be found in the appropriate sections below.

Unit 2

Malaria Key facts about malaria in Nigeria: ■ ■ ■ ■ ■ ■ ■

More than 90% of the population is at risk. 50% of the population suffers at least one malaria attack per year. Malaria accounts for 66% of all clinic visits. Children will be sick with malaria, on average, twice per year. There are 56M episodes of malaria in children under five every year. Malaria is the most common cause of absenteeism from school and work. Malaria is responsible for: ❏ 30% of childhood mortality ❏ 25% of infant mortality ❏ 11% of maternal mortality

What is malaria? Malaria is a very serious disease caused by a parasite called Plasmodium. The most common and dangerous type of parasite is Plasmodium falciparum, which can kill a child within 24 hours of onset of symptoms, most importantly, fever.

How is malaria transmitted? The parasite is transmitted by the bite of an infected mosquito. THE ONLY WAY TO GET MALARIA IS THROUGH THE BITE OF A MOSQUITO.

Appendix 19 / Example of training manual for supervisors and volunteers //

117

What are the signs and symptoms of malaria? Fever is the most common sign of malaria. All fevers should be treated within 24 hours of onset. In Nigeria, any patient with a fever or a history of fever, or any child who feels hot / has a temperature, should immediately suspect malaria and attend the nearest health facility for treatment. Other common signs of malaria include: ■ Headache; ■ Joint pains and weakness; ■ Muscle pains; ■ Abdominal pain; ■ Generalised malaise. Children suffering from malaria may refuse to feed and vomiting may occur. If a fever is left untreated, malaria can rapidly develop into a life-threatening illness, which is often called “severe malaria.” Severe malaria is most common in children under five and pregnant women. Severe malaria is extremely serious and can rapidly lead to death. Severe malaria is characterized by some or all of the following symptoms: ■ Inability to eat or drink; ■ Convulsions; ■ Vomiting everything; ■ Loss of consciousness; ■ Difficulty breathing; ■ Passing little urine or urine that has the colour of Coca-Cola; ■ Jaundice (yellowing of the eyes, palms or feet); ■ Inability to walk or stand without assistance. The symptoms of malaria are not the same with every individual. It is important that all people with fever are immediately seen by a health professional for testing and treatment.

How do you treat malaria? In Nigeria, episodes of uncomplicated malaria are treated with ACTs (Artemisinin Combination Therapy). ACTs for treatment of malaria in children under five and pregnant women are available free of charge in Government health facilities. All fevers should be diagnosed and treated by a health practitioner immediately upon onset. All cases of fever in Nigeria should be considered to be malaria and should be taken seriously. If a fever is left untreated, the patient risks developing severe malaria, which can lead to death. Severe malaria MUST be treated by a health practitioner at a health facility. Severe malaria is treated with quinine and the patient must be closely monitored by a trained health professional.

Who is at risk of contracting malaria? Everyone in Nigeria is at risk of malaria. The most vulnerable groups for malaria infection are: ■ Children under five years of age; ■ Pregnant women; ■ People with HIV/AIDS; ■ Elderly people.

How do you prevent malaria? The most effective way to prevent malaria is by sleeping under an insecticide treated mosquito net, which will reduce exposure to the mosquito that transmits the parasite. The mosquito that transmits malaria bites most commonly between dusk and dawn. Insecticide treated mosquito nets are an effective and cost efficient tool for malaria control.

LLIN scale-up and hang-up programme

118

International Federation of Red Cross and Red Crescent Societies

There are three types of mosquito nets: ■ Untreated Nets: These are nets that have not been dipped in insecticide. The use of untreated nets may protect the person sleeping under the net, but mosquitoes will be deflected to other unprotected individuals in the household and may transmit malaria. Untreated nets should be replaced with nets that have been treated with insecticide, preferably LLINs, to offer more protection to members of the household. ■ Insecticide Treated Nets (ITNs): These are nets that have been dipped in insecticide. These nets will kill or knock down mosquitoes, therefore protecting individuals who are not sleeping under the net, as well as the people that are physically protected by the net barrier. The insecticide on ITNs is good for a period of 6-12 months (depending on insecticide), after which the net must be retreated. If these nets are not retreated, they have the same protective value as an untreated net. Where possible, these nets should be replaced with LLINs, which are nets that have been treated with an insecticide at the factory during production. ■ Long Lasting Insecticidal Nets (LLINs): These are nets that are treated with insecticide at the factory during production. They have the same properties as ITNs, with the advantage that the insecticide will last for a period of 3 to 5 years. LLINs DO NOT have to be retreated before this period expires. LLINs are the recommended net for the greatest protection of household members over a long period of time. During the Integrated Measles Campaign, the MoH/RBM and partners will distribute LLINs to children 0-59 months of age who attend vaccination posts. The net distribution strategy is one net per child vaccinated. Therefore, every child receiving vaccination will receive a LLIN. LLINs can be washed 20 times before the insecticide becomes ineffective. People should not wash the nets too often or wash them with strong soaps as this will reduce the power of the insecticide. LLINs have a number of advantages: ■ Protection from mosquito bites. ■ Cost-effective. ■ Kills some other insects. ■ Reduces morbidity and mortality in children under five and pregnant women due to malaria and other causes.

How are LLINs used? In order to be effective, LLINs must be hung and properly used. ■ The net has hooks at four corners that should be used to tie the net up:

Appendix 19 / Example of training manual for supervisors and volunteers //

■

119

The net must be hanging low enough to tuck under the mattress or mat, in order to prevent entry of mosquitoes:

Malaria and Pregnancy Pregnant women are at high risk of malaria infection. Malaria is very dangerous to both pregnant women and to their unborn babies. Malaria infection in pregnant mothers increases the risk of: ■ Spontaneous abortion; ■ Stillbirth; ■ Pre-term birth; ■ Low birth weight; ■ Maternal anaemia. In some cases, malaria parasites can cross from the placenta into the baby’s blood and cause anaemia in the baby. Intermittent Preventive Treatment or IPT is the provision of SP (Fansidar) for presumptive treatment of malaria during the second and third trimester of pregnancy to clear malaria parasites. All pregnant women should attend an antenatal clinic (ANC) to be provided with IPT for malaria prevention.

Key malaria messages for integrated measles campaign 1. 2. 3. 4. 5. 6. 7. 8.

The only cause of malaria is mosquitoes. Malaria is a very serious disease that can quickly lead to death. All fevers should be immediately treated by a trained health practitioner. The most vulnerable groups are children under five and pregnant women. Pregnant women should attend ANC to receive malaria treatment. LLINs are an effective method of preventing malaria infection at low cost. LLINs should be hung and used every night throughout the year. LLINs should be aired outdoors in the shade for 24 hours prior to use.

Note: Unit 3: Measles, Unit 4: Vitamin A deficiency and Unit 5: Polio can be found on the accompanying CD.

LLIN scale-up and hang-up programme

120

International Federation of Red Cross and Red Crescent Societies

Unit 6

Site set up, volunteer tasks and key messages Site Organization The Nigeria Integrated Measles Campaign (IMC) is based on a fixed site strategy. This means that all recipients of campaign interventions will visit a site (health center/fixed post or temporary fixed sites/posts) to protect their children from measles, polio, vitamin A deficiency and malaria.

Fixed Posts: The most common location for the integrated measles campaign is in fixed health posts or peripheral health units. Normally, and where infrastructure permits, fixed sites will be organized as in the example below (see Figure 1).

Temporary Fixed Posts: These posts may be located at schools, mosques/churches, houses of traditional leaders, bus stops, streets and bus terminals, motor parks, hard-to-reach areas, border (local and international) and market areas. Immunization will be provided at these sites for either the duration of the campaign or partially depending on the population density. See Figure 1 for typical site organization.

Staffing of Vaccination Posts: The vaccination post team supervisor is responsible for site set-up, designation of tasks and supervision of activities. All partners act under the responsibility of the supervisor. Each vaccination team will have a minimum of 8 members: 1. Vaccination post team supervisor: responsible to oversee all activities related to the vaccination post. 2. Crowd Controller: mobilizes the community to the vaccination post and ensures orderly flow of clients at the vaccination post. 3. Screening Recorder: checks if child is within the target age groups for the interventions and fills the summary form and submits it to the supervisor. 4. OPV/Vitamin A Administrator: administers OPV and vitamin A, tallies children and paints left little finger, directs clients to next table, advises mother about routine immunization. 5. Measles vaccinators (2): administers the measles vaccine, monitors and responds to reactions to measles vaccine, tallies every child vaccinated and paints left thumb, directs clients to next table, informs mother of possible secondary effects of vaccination, advises mother about routine immunization. 6. LLIN team (1 recorder, 1 distributor): registers name of child and details, give one LLIN to every child vaccinated, tallies every child and paints the left middle finger, demonstrates how to use the LLIN, tells the caregiver to open the net package and expose the net for 24 hours prior to use.

General Elements of a Good Vaccination Site: ■ ■ ■ ■ ■ ■ ■

Shade; Good client flow; Posters and banners to help identify the vaccination post; Demonstration of LLIN hanging for sensitization; Highly visible and known location; Adequate space for crowds; Highly accessible to beneficiary population.

Appendix 19 / Example of training manual for supervisors and volunteers //

121

Figure 1: Fixed site set up Filter for order Registration Polio/Vit A Measles Exit

LLINs Where adequate numbers of volunteers, LLIN hanging sensitization post-distribution

Nigerian Red Cross Volunteer Tasks: Nigerian Red Cross volunteers will be assigned tasks by the Vaccination Post Team Supervisor. Possible tasks of NRCS volunteers include the following:

Crowd Control ■ ■ ■ ■ ■ ■ ■

Crowd control should begin as far from the screener recorder table as possible. Urban sites should consider setting up a ‘corridor’ made from ropes and sticks to control flow of people entering site. Design the post in such a way as to ensure easy and smooth flow of people from one intervention table to the next. Avoid overcrowding through regulation at entry and exit sites and through avoiding accumulations of individuals not receiving interventions (e.g. vendors). Avoid clients waiting for too long at any of the intervention tables, which may cause some mothers to leave without their children being vaccinated. Ensure that mothers whose children have received the interventions leave the vaccination post to avoid overcrowding. To ensure an efficient client flow, the vaccination post should have: ❏ Enough space; ❏ Adequate number of volunteers to help run the post.

Recorder Screener The recorder screener welcomes mothers and children to the site and determines which children will receive which interventions according to age. The role of the recorder screener is: ■ Welcome the mother and child/ren. ■ Ensure effective identification of children for each intervention. ■ Allocate interventions according to age of child. ■ Answer questions if asked. ■ Direct mothers and children to their first table. The Vaccination Post Team Supervisor will instruct the recorder screener regarding determining age of child where the age of the child is unknown.

Administration of Vitamin A and Oral Polio Vaccine The NRCS volunteer may be asked to administer the Vitamin A and Oral Polio Vaccine. Vitamin A: ■ Give children 6 to 11 months 100,000 IU (1 blue supplement). ■ Give children 1 to 4 years 200,000 IU (1 red supplement).

LLIN scale-up and hang-up programme

122

International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■ ■

Cut the nipple off the supplement with scissors. Squeeze the content of the supplement into the mouth of the child. Dispose empty shells of the supplement into the waste disposal. Inform the mother that Vitamin A supplementation should be given every six months until the child is five years old. Mark the tally sheet.

Oral Polio Vaccine: ■ Give to all children aged 0 to 59 months. ■ Each child should receive 2 drops of polio in their mouth. ■ Inform the mother that there are no harmful effects from the polio vaccine and that the vaccine is the only way to prevent her child having polio. ■ Advise the mother to take the child for routine vaccination services to complete the vaccination series. ■ Mark the baby finger of the left hand to demonstrate that the child has received the polio vaccine. ■ Mark the tally sheet. Once the child has received the Vitamin A and OPV (according to eligibility), direct the mother to the next table.

Distribution of LLINs Two volunteers will be required for the LLIN table. One will distribute the LLIN and the other will register the beneficiaries, fill in the tally sheet and mark the child and mother’s nails. Tasks for the LLIN distribution team include: ■ Ensure that there is a net set up properly to demonstrate to mothers how the net should be hung and used. ■ Give the net to the mother WITH THE PACKAGING TORN OPEN to deter resale of the nets in the market. ■ Explain to the mother that the net is for children under five. ■ Tell the mother that the net must be AIRED OUTDOORS FOR 24 HOURS prior to being hung in the home. ■ Show the mother the net that is hanging for demonstration of use and explain that the NET MUST BE HUNG LOW ENOUGH TO BE TUCKED UNDER THE MAT OR MATTRESS. ■ Mark the child/ren and the mother on the middle finger of the left hand to indicate the LLIN has been received.

Appendix 19 / Example of training manual for supervisors and volunteers //

123

How to Mark the Mother and Child/ren with Indelible Ink The mother and child will be marked with indelible ink to ensure that they do not bring their children back through the vaccination line to receive another net or any of the other interventions in order to receive another net. Mothers and children should be marked: ■ On the thumb nail of the left hand for measles vaccination. ■ On the baby finger nail of the left hand for polio vaccination. ■ On the middle finger nail of the left hand for LLIN reception. The mark should be made across the base of the nail where the nail and skin meet. The ink needs to dry for 15-20 seconds before it is touched so that it will stay on the finger. The cap should be immediately put back on the marker when it is not being used.

Unit 7

Report writing and post campaign The two supervisors for each LGA should work together to produce one report per LGA that includes both narrative and financial elements. Ensure these two parts of the report are submitted together to the branch secretary, branch health coordinator and/or the mother’s club coordinator.

Narrative report ■ ■

■ ■ ■ ■

Introduction Activities achieved ❏ Training ❏ Pre-campaign mobilization ❏ During campaign volunteer activities ❏ Supervision ❏ Post-campaign household visit and data collection ❏ Identification of non-attending children and referral to routine ❏ Data collation and analysis ❏ Houses/beneficiaries reached by NRCS volunteers Relation with Ministry of Health and NRCS roles undertaken Objectives set and achievements (coverage of interventions + utilization of LLINs) Challenges Recommendations

Where possible, you should include photographs, volunteers’ stories and quotes from beneficiaries about the impact of the integrated measles campaign.

Ensure you collect and keep the records before, during and after the campaign. ■ ■

Number of coaches and volunteers, names and places they are assigned. Name and age of child/ren, name of guardian, LLINs received/hanging (post-campaign visits)

Financial report ■ ■ ■ ■

Monetary resources allocated Monetary resources utilized Balance of remaining funds (note that these must be returned to Branch responsible) Supporting documentation/receipts for every expenditure, including signed forms for payment to volunteers for activities

LLIN scale-up and hang-up programme

124

International Federation of Red Cross and Red Crescent Societies

Appendix 20 Supervisor job aids Nigeria Integrated Measles Campaign Duties of Nigerian Red Cross Supervisors Pre-Campaign Activities Your Duties and Responsibilities:

■

■

■

■ ■ ■

■

■

■

■

■ ■

■

Work with the other supervisor in your LGA to prepare a list of all volunteers under your responsibility. Once the list has been prepared, you should sub-divide the list into 2 groups of 25 volunteers based on the location of volunteers and supervisors. You should train volunteers under your management to understand and undertake all tasks during all stages of the campaign as detailed in the “Duties of Nigeria Red Cross Volunteers” sheets. During the training, you should make sure that volunteers are aware of their role vis-à-vis the Ministry of Health, the activities that they are to implement before, during and the campaign and how these activities will be evaluated. Make sure that all volunteers under your supervision are aware of the child protection and abuse module and what actions to take if they encounter situations requiring attention. Ensure volunteers are fully aware of the specific NRCS plan for social mobilization in their communities and their own role within that plan. Ensure that volunteers understand the key messages (as listed in the volunteer duty sheets) regarding measles, polio, Vitamin A and malaria specifically, as well as the general campaign messages about dates, time and place. Ensure that volunteers under your supervision disseminate key messages to their communities through house-to-house visits or community meetings to guarantee participation of mothers and children during the campaign. Maintain regular contact with Ministry of Health staff at the level of LGA, ward and health facility. Ensure that the Ministry of Health staff are aware of the number of volunteers available and their locations. Maintain regular contact with volunteers via cell phone or meetings from the time of the training through to completion of post-campaign activities. Assist the volunteers under your supervision in finding solutions to difficulties encountered. Meet with volunteers at the end of the pre-campaign period and before the start of the campaign to ensure work has proceeded as planned and address any issues arising regarding planned campaign activities. Be sure, during the training, that volunteers understand how important it is for them to be clearly identified as NRCS volunteers by wearing their bib and introducing themselves appropriately. Ensure that all volunteers are given their volunteer incentives (including their bibs and per diem) for their activities. Volunteers should only be given per diem for days on which they are active. Ensure that you keep track of money that has been given to you and money you have paid out by getting signatures from all recipients. Note that per diem for pre-campaign volunteer activities will be paid at the end of the volunteer training period.

Activities During Campaign Your Duties and Responsibilities:

■

■

Meet with volunteers before the start of campaign period (see above) to ensure pre-campaign activities have proceeded as planned and address any issues arising regarding planned campaign activities. Meet with the Ministry of Health staff at the LGA, ward and health facility staff before the campaign begins to ensure that the volunteers under your supervision are attached to vaccination posts and that the vaccination post team supervisor knows the names and capacities of the volunteers that will be working at the post.

Appendix 20 / Supervisor job aids //

■ ■ ■

■ ■

■

■

125

Ensure that the volunteers under your supervision know which posts they are assigned to and at what time they should report to the vaccination post team supervisor. With the volunteers under your supervision, assist the vaccination post team supervisor with the setting up of vaccination sites. Work with the vaccination post team supervisor to assign tasks, roles and responsibilities to the NRCS volunteers. These tasks may include: ❏ Organizing beneficiaries ❏ Registration ❏ Administration of Vitamin A and polio vaccine ❏ Distribution of LLINs Work with the vaccination post team supervisor and NRCS volunteers to ensure that there is a net hanging to demonstrate proper use. You should move from vaccination post to vaccination post to ensure that NRCS volunteers under your responsibility are: ❏ Present at posts they have been assigned to ❏ Well-identified as NRCS volunteers through wearing their bib ❏ Performing the functions assigned to them in a professional manner At each vaccination post that you visit during your supervision mission, you should discuss with the vaccination post team supervisor: ❏ The conduct, performance and attendance of NRCS volunteers at the site ❏ Any challenges arising and whether you can assist in resolving them ❏ The overall situation at the vaccination post over the course of that day ❏ The participation of beneficiaries at the site and whether NRCS could improve any deficiencies by undertaking additional social mobilization activities You should ensure that the vaccination post team supervisor has an attendance sheet for the NRCS volunteers assigned to their site. Volunteers should sign the sheet each day and payment will be made at the end of the campaign period only for days worked by each volunteer.

Post Campaign Activities Your Duties and Responsibilities:

■

■

■ ■ ■ ■

■

■

Meet with the Ministry of Health staff at the health facility, ward and LGA levels to discuss any challenges arising over the campaign period and how these were resolved. You should discuss any specific issues with the volunteers under your supervision. Ensure that volunteers under your supervision undertake the tasks as described in the “Duties of Nigerian Red Cross Volunteers” sheets. You should undertake supervision visits during the post-campaign period to guarantee that volunteers are performing their task of visiting 15 households each day. After the NRCS volunteer door-to-door activities, collect all of the notebooks from the volunteers under your supervision that have been used to collect data. At the time that you collect the notebooks, you should look at the number of days of activities and pay the volunteers their per diems for days worked. Summarize the data that the volunteers have collected in their notebooks in the “Data Summary Form.” You are responsible for writing two types of report: financial and narrative. The narrative and financial reports are due on January 9th at the branch office. Final supervisor payments will be made upon submission of the final report. Your financial report must include: ❏ Monetary resources allocated ❏ Monetary resources utilized ❏ Balance of remaining funds (note that these must be returned to Branch responsible) ❏ Supporting documentation/receipts for every expenditure, including signed forms for payment to volunteers for activities Your narrative report should include: ❏ Introduction ❏ Activities achieved:

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

■ ■ ■ ■ ■ ■ ■ ■

Training Pre-campaign mobilization During campaign volunteer activities Supervision Post-campaign household visit and data collection Identification of non-attending children and referral to routine Data collation and analysis Houses/beneficiaries reached by NRCS volunteers ❏ Relation with Ministry of Health and NRCS roles undertaken ❏ Objectives set and achievements (coverage of interventions + utilization of LLINs) ❏ Challenges ❏ Recommendations

126

Appendix 21 / Volunteer job support //

127

Appendix 21 Volunteer job support Nigeria Integrated Measles Campaign Duties of Nigerian Red Cross Volunteers Pre-Campaign Activities Your tasks:

■

■

■

■

■

■

■

When you are going to houses or to community meetings, you must ensure that you are well identified as a Nigeria Red Cross volunteer. You should wear your bib for all activities that you undertake when you are acting as a volunteer. Ensure that the communities you work in are fully informed about the integrated measles campaign (IMC), which includes vaccination against measles and polio, Vitamin A supplementation and distribution of Long-Lasting Insecticide Treated Mosquito Nets (LLINs). Undertake house-to-house visits and community meetings to inform your community about the IMC. You should pay special attention to high risk areas where there is a possibility that children will not be brought to vaccination posts due to lack of understanding or other barriers. During your house-to-house visits and community meetings you should: ❏ Introduce yourself to each mother/family and explain the purpose of your visit. ❏ Explain when and where the campaign will take place. ❏ Give mothers/families the key messages about the IMC that are found below. Explain why it is important that all children under five are taken to the vaccination post. Discuss the importance of the campaign with the mother/family and explain that all children under five years of age, regardless of vaccination status, should be brought to the nearest post. Explain that mosquito nets will be distributed to every child receiving vaccination against measles and polio and supplementation with Vitamin A. Deliver the key messages regarding the package of interventions that children will receive. Make sure that the mother/family knows when the IMC will take place and where they should go to receive the interventions that will protect their child/ren against common childhood diseases. Comply with all child protection directives regarding your conduct throughout all periods of the campaign.

Key messages about the integrated measles campaign 1. Mothers should bring all children 0-59 months to the closest vaccination post from 8th to 12th December 2008. 2. Children of eligible ages will receive: a. Measles vaccination (9-59 months) b. Vitamin A supplementation (6-59 months) c. OPV (0-59 months) d. LLIN (0-59 months) 3. All of the campaign interventions are free of charge.

Activities During Campaign Your tasks:

■ ■ ■

When you are going to vaccination posts, you must ensure that you are well identified as a Nigeria Red Cross volunteer. Ensure that mothers/families bring all children under five years of age to the vaccination post to receive all interventions. Assist the MoH Vaccination Post Team Supervisor with setting up the vaccination post. You should undertake the tasks that you are assigned as a member of the vaccination post team.

LLIN scale-up and hang-up programme

128

International Federation of Red Cross and Red Crescent Societies

■

■

As a NRCS volunteer, your tasks may include: ❏ Crowd control and organization of beneficiaries ❏ Welcoming and registering mothers and children ❏ Administration of Vitamin A and vaccination against polio ❏ Distribution of mosquito nets ➥ Provide each child vaccinated with a mosquito net. ➥ Tear the packaging of the net to deter resale in the market. ➥ Explain to mothers the importance of the proper use of the net every night all year round. At the vaccination post, you should make sure that there is a mosquito net hanging to demonstrate proper use.

Key messages to deliver to mothers 1. You should hang your mosquito net outside in the shade for 24 hours before hanging it in your house. 2. It is important that you hang the net properly. The net must reach the ground so that you can tuck it under your mat or mattress. 3. You should ensure that you and your child/ren use the net every night all year round. 4. Vaccination is important to protect your child/ren. Take your child/ren to the nearest Government health facility to complete the routine vaccination series. 5. Every six months, your child/ren should receive Vitamin A supplementation. Make sure that you take your child/ren to the nearest Government health facility for free Vitamin A supplementation.

How to use the impregnated mosquito net: The mosquito net must be hung in a way to cover the entire sleeping area and must be tucked under the mat or mattress. Attach strings to the four corners (loops) of the mosquito net.

Attach the four corners of your mosquito net to hooks (or other supports) on the roof or wall.

Appendix 21 / Volunteer job support //

129

Make sure mosquitoes cannot enter underneath the mosquito net by tucking the net under your mattress or mat. After washing the net, hang it to dry outside in the shade.

When you wash your mosquito net, do not use strong soaps, bleach or hot water. When you are drying the mosquito net, do not expose it to direct sunlight.

Post Campaign Activities Your tasks:

■

■ ■

When you are going to houses, you must ensure that you are well identified as a Nigeria Red Cross volunteer. You should wear your bib for all activities that you undertake when you are acting as a volunteer. You should try to visit at least 15 households on each of the 7 days that you are doing Hang Up activities after the IMC and mosquito net distribution. During your house-to-house post-campaign activities you should: ❏ Introduce yourself to each mother/family and explain the purpose of your visit. ❏ Explain the data you are collecting and why it is being collected. ❏ Ensure that the net is hanging properly. If possible, you should ask to view the net hanging.

LLIN scale-up and hang-up programme

130

International Federation of Red Cross and Red Crescent Societies

If the net is not hanging, you should ask the mother/family if they would like you to assist with hanging the net for them. You should fill out one Household Visit Form on each day of your post-campaign activities. ❏

■

Key messages to deliver to mothers and families 1. The only cause of malaria is mosquitoes. LLINs will protect you and your family from mosquito bites and malaria. 2. Young children and pregnant women are at the most risk of malaria and must sleep under the mosquito net every night all year round. 3. Children must go to sleep early under the mosquito net as mosquitoes are active from sundown until sun up 4. It is important that you hang the net properly. The net must reach the ground so that you can tuck it under your mat or mattress. 5. Vaccination protects your child from killer diseases and is provided free of charge at all Government health facilities. All children need to complete the vaccination schedule to protect their children. 6. Fever is the most common sign of malaria. All fevers should be considered as malaria and should be diagnosed and treated by a trained health professional.

Appendix 22 / Sample data collection form for household visits by volunteers //

131

Appendix 22 Sample data collection form for household visits by volunteers Nigerian Red Cross volunteer household visit form Name of volunteer: ______________________________________

Name of supervisor: _____________________________________

Name of community: ____________________________________

Date of visit: ____________________________________________

Name of ward: __________________________________________

Name of LGA:___________________________________________

Household identification

Name of household head

Name of household members

Age/Sex

Pregnant Y/N

At the end of each day of household visits, the volunteer should summarize the following information: 1 - Number of households visited 2 - Number of under fives 3 - Number of children vaccinated 4 - Number of nets received 5 - Number of nets hanging 6 - Number of children sleeping under nets

Vaccine Y/N

LLIN Rec’d Y/N

LLIN Hanging Y/N

Slept under LLIN Y/N

LLIN scale-up and hang-up programme

132

International Federation of Red Cross and Red Crescent Societies

Appendix 23 Sample data collection form for supervisors Nigerian Red Cross supervisor summary form Name of supervisor: _____________________________________

Name of LGA:___________________________________________

How many volunteers are under your supervision? NOTE: Each supervisor should have 25 volunteers, but there maybe dropouts. How many households did your volunteers visit during the 7 day post-campaign period? NOTE: 25 volunteers X 15 household visits per day X 7 days = 2,625 households visited. In the households visits post-campaign, how many under fives were counted? Of the under fives counted, how many were vaccinated during the IMC? NOTE: If you have 100 under fives, ideally 100 were vaccinated. Is the number of children vaccinated is lower than the total number of children under five? If yes, why do you think there is a difference? Please explain in your final report. How many nets were received by the children under five counted? NOTE: If you have 100 under fives, ideally 100 received nets. Is the number of children who received nets is lower than the total number of children under five? If yes, why do you think there is a difference? Please explain in your final report. Of the total number of nets received, how many of the nets were hanging? NOTE: If you have 100 nets, ideally 100 are hanging. Is the number of nets hanging is lower than the total number of nets received? If yes, why do you think there is a difference? Please explain in your final report. Of the total number of children counted, how many of them were sleeping under a net? NOTE: If you have 100 children under five, ideally 100 are sleeping under nets. Is the number of children sleeping under nets is lower than the number of nets available? If yes, why do you think there is a difference? Please explain in your final report. Post-campaign, volunteers should summarize the following information daily: 1 - Number of households visited 2 - Number of under fives 3 - Number of children vaccinated 4 - Number of nets received 5 - Number of nets hanging 6 - Number of children sleeping under netsd

Appendix 24 / Sample data collection form for semi-literate volunteers //

133

Appendix 24 Sample data collection form for semi-literate volunteers Household visit record Name of volunteer_______________________ Name of coach _________________________

Keep-up programme

Location _______________________

Reporting period from _________ to _________

Attending meeting with coach this period? Y N

Date of supervision meeting________

Total nomber of households under this volunteers responsabilit _____________ h/h visit recorded

Any new births in this h/h?

Tick for each birth 1 2 3 4

No of chrn. < 5yrs Any ITN (at least 1) (excluding new in household? births)?

No of < 5s slept under ITN last nighy

No of < 5 with vaccination card

Tick for each birth

Tick for each child

Tick for each child with a card shown

Tick if YES or for cach net

No of women in No of preg.women houschold slept inder ITN currently pregnant last night

Tick for each woman

Tick for each woman

LLIN scale-up and hang-up programme

134

International Federation of Red Cross and Red Crescent Societies

Appendix 25 Example of an integrated vaccination card

Integrated Child Survival Campaign Sierra Leone November 20-26, 2006

Measles 9-59 months

Vitamin A 6-59 months

Mebendazole 12-59 months

LLIN 0-59 months

Appendix 26 / Key targets for social mobilization //

135

Appendix 26 Key targets for social mobilization The following is a list of target individuals, groups and social institutions that should form key targets for social mobilization. Community institution

Objective/measurable indicator

Paramount ruler (head of district)

Identify and map traditional leadership including village heads.

Mosques/churches

Identify and map denominational/sect groups, religious representatives and principal mosques/churches. Measure % influencing in favour of/against.

NGOs/CBOs

Identify and map NGOs/CBOs by type of work. Identify potential contributions to EPI and SIAs. Identify measurable indicators for positive/negative SM/C impact on NGO/CBO contribution.

Schools

Identify and map all schools (public and private, including play schools). Identify head teachers. Contact and secure agreement to make school children available for vaccination (inc. involvement of board of education).

Local government representatives

Identify and diagram key government representatives (chairman, health education representative, religious affairs representative, education representative). Identify key potential contributions to health matters.

Major markets

Identify map and time major markets. Identify SM/C input.

Profile of religions distribution

Map out different denominational/sectoral areas. Identify strategies for each.

Distribution of settled and mobile populations Identify seasonal and other mobile populations. Distribution of language groups

Identify and map different language group areas. Identify personnel and material needs to address these.

Characteristics of geographical access

Identify and map areas of difficult access (permanent and seasonal). Identify logistics requirements to ensure access.

Reference: Guide for Integrated Campaigns, WHO Regional Office for Africa.

LLIN scale-up and hang-up programme International Federation of Red Cross and Red Crescent Societies

Appendix 27 Child protection

136

Appendix 28 / A training guide on child protection //

137

Appendix 28 A training guide on child protection Child protection module Training curriculum

Suggested presentation times 2 hours (including 10-minute break) for training of trainers. Use all sections. 1 hour for training of volunteers. Use only those sections in grey boxes.

Table of contents Introduction Types of violence and abuse against children Best practices for contact with children Local and international laws Community support Conclusion

Section

Steps

Introduction

1. Introduce yourself

5 minutes

2. Explain the objectives of the child protection module: To provide an introduction to the various forms of violence against children and to identify prevention strategies and how to report any concerns.

Types of child abuse

1. Explain that violence can take many forms. It can be against one’s self, another person or a group of people. Abuse of power is part of all forms of violence.

Trainers: 30 minutes

2. Define child abuse.

Volunteers: 10 minutes

3. In small groups ask participants to define: ■ sexual abuse ■ physical abuse ■ family violence ■ emotional abuse ■ neglect If the definitions are written on a flip chart, groups can be rotated from one sheet to another, every two or three minutes. 4. Ask groups to read out definitions and give examples of each type of abuse. 5. Ask the same groups to list the different settings where children can be vulnerable to violence and abuse. The responses should include: ■ homes ■ schools ■ workplaces ■ institutions ■ communities 6. Explain that child abuse is a complicated problem and many factors are linked and can increase abuse: personal, family, community and cultural factors.

LLIN scale-up and hang-up programme

138

International Federation of Red Cross and Red Crescent Societies

Section

Steps

Best practices for contact with children

1. Discuss best practices for interacting with children. In small groups ask participants to list what things that staff or volunteers should not do to children. The list should include: ■ hit or physically harm ■ develop physical or sexual relationships ■ use language, gestures or other behaviours that are sexual ■ use language, gestures or behaviours that scare, degrade, humiliate, reject, isolate, corrupt or terrorize ■ intentionally view, download or distribute any sexualized, demeaning or violent images involving children ■ take pictures of children that can be interpreted as sexualized, demeaning or violent ■ develop relationships with children that can be considered exploitative, violent or abusive

20 minutes

2. List situations and possible risks when children are isolated with Red Cross Red Crescent staff and volunteers. Examples of situations may include: ■ home visits ■ IDP or refugee camps (shelters, tents, etc.) ■ medical facilities ■ vehicles ■ closed rooms ■ unsupervised areas 3. Explain strategies to help reduce risk in interactions with children, especially in isolated situations. Emphasize that staff and volunteers should not interact with children in isolation. Instead staff and volunteers can: ■ move a child out of hearing but in sight of others ■ ensure there are at least two staff or volunteers in an isolated area with a child ■ it is ideal that at least one of the staff or volunteers be the same sex as the child

Local and international laws Trainers: 20 minutes

1. Explain that child abuse is unacceptable in any form. 2. Explain the local laws on child protection – (Interpol has a database on child sexual abuse laws at: www.interpol.int/Public/Children/SexualAbuse/NationalLaws/Default.asp and further information can be obtained from the police or child protection authority).

Volunteers: 10 minutes 3. Introduce and discuss the main themes of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child. Ask the group (in a large group or in small teams) to list what things each child deserves, and explain that these are covered by the United Nations convention and the African charter. Emphasize that every child deserves these things – there are no exceptions. The list should include the rights to: ■ safety/protection/security ■ health ■ participation (some say in the issues that affect them) ■ education ■ nutritious food ■ shelter ■ care and affection from parents or guardians ■ play (it is the best way that children learn as they are growing)

Appendix 28 / A training guide on child protection //

139

Section

Steps

Community support and reporting

1. Ask the group to discuss in small groups how they would respond if a child needed help. ■ What would you do? ■ Who can you talk to? ■ How do you contact helping persons in your community? ■ Where can you get help for yourself?

Trainers: 20 minutes Volunteers: 10 minutes

Explain that child abuse is against the law. If you know or have reasonable grounds to suspect that a child is being abused, promptly report your concerns following local laws. You may also report to your supervisor, human resources, or senior leadership within the National Society. For all reports the ‘Reporting form for disclosures of violence against children’ should be filled and provided to the appropriate person within the National Society. 2. Discuss the answers from each group as a large group.

Conclusion Trainers: 10 minutes Volunteers: 5 minutes

1. Reinforce that all Red Cross Red Crescent staff and volunteers have an important role in keeping children safe. No violence against children is acceptable, and all violence against children is preventable. You may choose to write out or read the following quote from Nelson Mandela: “We owe our children – the most vulnerable citizens in any society – a life free from violence and fear.” 2. Provide participants with a copy of the child protection learning module (for trainers) or the one-page fact sheet (for volunteers). 3. Thank participants.

LLIN scale-up and hang-up programme

140

International Federation of Red Cross and Red Crescent Societies

Appendix 29 Reporting form for disclosures of violence against children Name of person making the report: __________________________________________________ Position:_________________________________________________________________________ Location: ________________________________________________________________________ Telephone: _______________________________________________________________________ Address: ________________________________________________________________________ Time of disclosure: ________________________________________________________________ Date: ___________________________________________________________________________ Context of disclosure: (Where? Who was there?)_______________________________________ Child’s name: ____________________________________________________________________ Age: ____________________________________________________________________________ Grade: __________________________________________________________________________ Community/Location:______________________________________________________________ Address: ________________________________________________________________________ Describe what the child said: (Record facts and statements, not interpretations.) ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Describe your observations of the child: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ To whom was the child referred? ____________________________________________________ Who reported to the child protection agency? Date/Time. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Who received the report? __________________________________________________________ Follow-up plans: __________________________________________________________________ Signature of person making report:

Date:

Signature of supervisor or human resources personnel or senior manager

Date:

Appendix 30 / Hang-up data collection summary form for volunteers //

141

Appendix 30 Hang-up data collection summary form for volunteers

District _________________________________

Commune ______________________________

Number of households targeted in campaign:

Name of volunteer_______________________

Name of supervisor _____________________

_______________________________________

A Date

Household visit form number

Day 1 Date

Form 1 Form 2 Form 3 Form 4 Form 5 Form 6

Day 2 Date

Form 1 Form 2 Form 3 Form 4 Form 5 Form 6

Day 3 Date

Form 1 Form 2 Form 3 Form 4 Form 5 Form 6

Day 4 Date

Form 1 Form 2 Form 3 Form 4 Form 5 Form 6

No. households visited

B

C

D

E

F

No. of mosquito No. of households No. of households No. of children >5 Among the nets in households with at least with at least one who sleep in the children >5, no. visited one ITN child under 5 years households visited who slept under (>5s) an ITN the previous night

G No. of households with an ITN hanging over sleeping space at time of visit

LLIN scale-up and hang-up programme

142

International Federation of Red Cross and Red Crescent Societies

Appendix 31 Hang-up data collection form for supervisors

Region _________________________________

District _________________________________

Campaign dates: ________________________

Name of supervisor _____________________

Number of volunteers you supervise ______

Number of households targeted in campaign: ____

A No.

Name of volunteer

Commune

No. of No. households households targeted visited

B

C

D

E

F

G

No. of No. of No. of No. of Among the No. of households mosquito households households children >5 children >5, no. with an ITN nets in with at with at least who sleep in who slept under hanging over households least one child under the households an ITN the sleeping space visited one ITN 5 years (>5s) visited previous night at time of visit

The Fundamental Principles of the International Red Cross and Red Crescent Movement

Humanity The International Red Cross and Red Crescent Movement, born of a desire to bring assistance without discrimination to the wounded on the battlefield, endeavours, in its international and national capacity, to prevent and alleviate human suffering wherever it may be found. Its purpose is to protect life and health and to ensure respect for the human being. It promotes mutual understanding, friendship, cooperation and lasting peace amongst all peoples.

Impartiality It makes no discrimination as to nationality, race, religious beliefs, class or political opinions. It endeavours to relieve the suffering of individuals, being guided solely by their needs, and to give priority to the most urgent cases of distress.

Neutrality In order to enjoy the confidence of all, the Movement may not take sides in hostilities or engage at any time in controversies of a political, racial, religious or ideological nature.

Independence The Movement is independent. The National Societies, while auxiliaries in the humanitarian services of their governments and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the Movement.

Voluntary service It is a voluntary relief movement not prompted in any manner by desire for gain.

Unity There can be only one Red Cross or Red Crescent Society in any one country. It must be open to all. It must carry on its humanitarian work throughout its territory.

Universality The International Red Cross and Red Crescent Movement, in which all societies have equal status and share equal responsibilities and duties in helping each other, is worldwide.

The International Federation of Red Cross and Red Crescent Societies promotes the humanitarian activities of National Societies among vulnerable people.

The International Federation, the National Societies and the International Committee of the Red Cross together constitute the International Red Cross and Red Crescent Movement.

Our world is in a mess. It’s time to make your move. ourworld-yourmove.org

119200 09/2009 E 1,000

By coordinating international disaster relief and encouraging development support it seeks to prevent and alleviate human suffering.