CD implementation Step 5

• Logistics for this channel have the best opportunity to link into existing transport, storage, and distribution systems. Tracking documentation, distribution, and resupply and reporting should primarily use the existing tools and systems.
• Resupply is the greatest challenge. This aspect may require parallel systems to be set up and additional budgets provided, because no other commodities of a similar bulk are distributed routinely within the health system, so resupply systems with adequate volume capacity are not already established. Partly because of this, resupply is a serious challenge in ANC and EPI distributions and is a weakness of many countries health facility–based distributions. Reliable resupply is more likely if-
  • Systems are designed with inputs from the district- and distribution-level personnel who understand the challenges and opportunities.
  • A single standard system is not dictated, but options are described to districts that can adopt the most appropriate system for their context and needs.
  • Clearly identified budget lines for districts resupply needs.
  • Performance for stock management is regularly reviewed, and reasons for weaknesses and opportunities for improvement, are discussed at review meetings, from district level up.
• Some countries have used a voucher system for health facility–based distribution; where a voucher is given to the target group at the ANC or EPI visit that can be redeemed at a local outlet for an ITN (perhaps with a contributory sum of money required from the recipient). Voucher systems, therefore, have very different logistics needs:
  • The focus on initial distribution and resupply to health facilities is on vouchers. As a far less bulky item, this means distribution costs are far lower and resupply can be done with other health facility documentary supplies.
  • Close engagement with the private sector is required to ensure all communities have access to participating outlets. Close discussions should be maintained to monitor and—if necessary—work to improve continued stock availability at these participating outlets.
• To streamline logistics management across the overall ITN distribution strategy, it is important to develop a resupply plan that supports all distribution mechanisms. ITNs do not need to be compartmentalized for different distribution schemes. One stock of ITNs can be held at the health facility and drawn on, as needed, for various methods of distribution.
• The VectorWorks document,Guide to Health Facility-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

• Logistics for this channel probably links closely to health facilities. It is possible to work outside the health facility network, if necessary, but linking to the health facility network brings opportunities for synergies and efficiencies.
• To streamline logistics management across the overall ITN distribution strategy, it is important to develop a resupply plan that supports all distribution mechanisms. ITNs do not need to be compartmentalized for different distribution schemes. One stock of ITNs can be held at the health facility and be drawn on, as needed, for various methods of distribution.
• Health facility–based distribution is probably in place throughout the country, so in areas where community-based distribution is added, the logistics plans should be identical up to the health facility level. If ITNs are not stored at health facilities, additional logistics planning is needed.
• Key points to plan are where coupon redemption points will be (i.e., where a household member can redeem their coupon for an ITN) and where resupply storage hubs will be.
  • Redemption points may be health facilities that also store ITNs for distribution through ANC and EPI clinics; or, they may be smaller points at the community level, such as volunteer’s houses, if health facilities are insufficient.
  • Storage hubs should be at health facilities if this network is sufficiently functional. If it is impossible to use health facilities, then look for other storage hubs—in schools, local organizations, or other.
• Options for distribution to community level redemption points include—
  • Pull: community representatives visit health facilities for stocks.
  • Push: health facility representatives, or local transporters hired by them (e.g., a local person using a bicycle) deliver stock to community distribution points.
• Most redemption points are unlikely to have sufficient space to store more than a few bales of ITNs. Where redemption points are in a community member’s house, this will be particularly true. Two bales of ITNs may be the average amount held at a redemption point.
• Setting a solid threshold that indicates the need for restocking is vital to preventing stockouts at the community level. Planners should choose a minimum quantity threshold for resupply (such as 10 ITNs, or the average number distributed in one month) to ensure that enough nets will be available to cover the demand between reorder and delivery. Minimum thresholds (the number of months’ worth of nets to trigger resupply) will depend on the size of the storage space, the catchment area’s population, and accessibility (which affects the frequency of resupply). Similarly, base the setting of maximum stock levels (such as three months) on the consumption rate, storage capacity, and estimated frequency of resupply.
• Quantification should have considered the likelihood of a higher initial demand than is expected by the system. Planners should remember this and be prepared for more frequent resupply requests, at least initially. It may also be worth considering increasing initial stock levels before the rainy season, for two reasons:
  • Redemption rates may peak during the rainy season, or as the rainy season approaches.
  • Mobility may be particularly poor during the rainy season in some areas, making it difficult to resupply a community.

The VectorWorks document, Guide to Community-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

• Most often, school-based distributions are done once per year. This means the distribution and resupply plans will differ considerably from the on-going health facility and community channels.
• Consult sub-national education personnel about the transport plan; they will have information on the accessibility of different schools.
• For distribution of ITNs through schools, through advanced planning of transport routes is important to improve adherence to schedules. Given the reach of schools into communities, transport is often a cumbersome task with some schools accessible only by boat, bicycle, or foot. It may be most practical to assign a specific transport agent (a local NGO, large project, or transport provider).
• Transport plans (and associated training) must ensure deliveries are during working hours.
• Most schools should have sufficient internal storage space for the ITNs.
• To reduce opportunities for theft, distribution of ITNs to target groups should take place no more than 1–2 days after arrival of ITNs at the school.
• Where storage is a problem; it may be necessary to support schools in finding alternative storage sites, or provide funds to allow schools to improve conditions—including security—of the areas designated for storage.
• Storage may also be a problem at the district level, and planners may need to consider hiring storage locations if government sites are insufficient. Careful review of storage requirements and availability should be part of the micro-planning process.
• The VectorWorks document, Guide to School-based Distribution of Insecticide-treated Nets, provides more detail on these issues.