Toward universal coverage of insecticide-treated nets in Sierra Leone

The Issue

Malaria is one of the leading causes of mortality and morbidity in Sierra Leone, which is among the world’s least developed countries, with high child and maternal mortality rates. DFID, Global Fund to Fight AIDS, Tuberculosis and Malaria, and World Vision funded a campaign to distribute long-lasting insecticide-treated nets (LLIN) nationwide, implemented by the Ministry of Health and Sanitation with UNICEF managing procurement and national coordination.

Tropical Health was commissioned by DFID to conduct a project completion review to measure performance against milestones and provide lessons learned and recommendations for future programming to help eliminate malaria in Sierra Leone.

Our Approach

Following quantitative and qualitative analyses and fieldwork, Tropical Health delivered a comprehensive Project Completion Review that outlined the project activities and interventions, which included distribution of LLINs as well as vitamin A and albendazole for children under 5, and measured outcomes and explained the impact of the Ebola outbreak on the campaign. The review report included nine lessons learned and outlined three challenges faced by the project (not including the external factor of the Ebola outbreak), eight recommendations for future programming, an assessment of value for money, financial management, risk management, and monitoring and evaluation activities.

Our Findings

Tropical Health concluded that while the post-campaign survey was not completed due to the Ebola outbreak, a proxy study showed that 89.6% of children under five had slept under an LLIN the night before, suggesting that the milestone of 90% had been achieved. Overall, Tropical Health found that the successful mass net distribution campaign and associated social mobilisation and communication campaigns have helped to alleviate pressure on the public health system in Sierra Leone. High coverage of LLIN can contribute to a mass effect, which can substantially reduce the incidence of malaria cases in communities, reducing the burden on the public health system and contributing to improving the health of Sierra Leoneans.