Step 3: Develop a Budget
- Develop a detailed budget listing all tasks included in the planning and implementation stages of the CD.
- Hold a coordination committee meeting to prepare budget (this can be the same meeting as the timeline).
- Review planning budget guidance.
- Prepare draft budget for further review and finalization.
Include the costs for the following main activities:
- Visits to review options and plan transport and storage networks.
- Planning and coordination meetings.
- Commodity procurement, including costs for quality assurance (QA) testing, if planned in-country.
- Central- and lower-level storage costs, including rental, security personnel, security, and other equipment (some storage may be available in district or other existing stores, but verify this after a logistics plan is in place).
- Transport costs will depend on the options (e.g., use of third party logistics suppliers, use of district teams, use of locally contracted transporters), which will vary by level and throughout the country.
- Printing and distribution costs for training materials, job aids, information, education, and communication/behavior change communication (IEC/BCC) materials, logistics tracking forms, reporting forms.
- Annual review and planning meetings.
- Roll-out training and, possibly, refresher training, if they are not planned as part of supervision.
- Supervision visits (can be linked to routine supervision).
- Data entry and analysis costs (if not part of routine data collection).access
- Possibly—contribution to systems that CD will rely on—supplies, running costs, and staff positions.
It is not possible to estimate what it will cost to deliver an ITN, because the costs vary considerably from setting to setting, by scale of the activity, and between the stages of startup and routine management. In the sections below, however, see what information is provided on issues to consider when planning budgets for these CD channels.
- Costs will largely depend on how integrated the distribution model is in the existing health system. Integration can reduce costs, improve efficiency, and improve understanding for personnel in their roles; but it can have a high cost if personnel or systems are overburdened and, as a result, quality suffers. To determine how best to balance the additional tasks, carefully discuss these issues with the distribution-level personnel.
- The VectorWorks document Guide to Health Facility-based Distribution of Insecticide-treated Nets provides more detail on these issues.
- Community-based distribution, a new approach, has limited information on costs. Because the design of this type of channel can vary so widely also means that costs will vary considerably.
- Costs (largely) unique to community-based distribution include—
- Costs for printing coupons (although some health facility–based distributions have similar costs when voucher systems are used).
- Costs for the wide network of personnel involved—community coupon distributors, community ITN distributors, etc.
- Costs for the transport, supervision, and data reporting for an expansive network of distribution points.
- Community-based distribution will probably start as a small pilot after it is adopted as an approach. One of the pilot objectives should be to gather good information on the costs involved. Ensuring that the pilot is designed to determine if the distribution approach is effective at increasing or maintaining ITN access will be important to allow planners to determine if the costs are worthwhile.
- The VectorWorks document, Guide to Community-based Distribution of Insecticide-treated Nets, provides more detail on these issues.
- Differences in non-commodity costs per ITN delivered appear to be driven by whether a separate registration exercise was conducted, the number of schools targeted, the number of students per school, and the size of the communications budget.
- Non-commodity cost centers are similar to those for other ITN distribution channels. Training of teachers to document distribution and promote bed net use, often done by Zonal Coordinators, in addition to transport and storage of ITNs, seem to be the most costly activities. Other non-commodity costs included supervision, communication (including printing), planning, and sensitization meetings.
- Some countries include budget lines for—
- Costs of giving ITNs to all teachers as an incentive.
- Costs associated with revised training when the models were redesigned. Nigeria increased their spending on training between the first and the second round to train school representatives in smaller groups.
- Potential opportunities for cost savings include—
- Linking activities to other large-scale school health programs (e.g. deworming); because of timing constraints and difference in target groups, no countries have taken these opportunities. Potential for savings on transport costs are limited because ITNs are bulky and cannot usually be easily combined with other commodities. However, there is a potential for saving on meetings, training, communications, supervision, and M&E costs.
- Avoiding a separate registration exercise, whenever possible. Countries found existing school enrollment data was sufficiently accurate and easily accessible by school supervisors.
- Utilizing accurate school enrollment data to ensure appropriate quantification to avoid reallocation of undistributed ITNs.
- Bulk packaging of ITNs (i.e., without the individual ITN packages) was used in Senegal and can potentially lower per net and operational costs. However, additional research is needed to build on findings from Senegal and to address potential concerns associated with this strategy. Some concerns include whether unpackaged nets (naked nets) are more vulnerable to damage or loss on the way home from school, whether skin irritation or rashes from insecticide exposure could cause problems, and to what extent used plastic bags at the household level pose significant solid waste or other problems. See resources section for more information on naked nets USAID DELIVER Project Long-Lasting Insecticide-Treated Bed Net Packaging
- The VectorWorks document, Guide to School-based Distribution of Insecticide-treated Nets, provides more detail on these issues.