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Rotarians Against Malaria ROTARIANS AGAINST MALARIA LONG LASTING INSECTICIDAL NET DISTRIBUTION REPORT Eastern Highlands Province Carried Out In Conjunction With The Provincial And District Government Health Services And The Church Health Services Of Eastern Highlands With Support From Against Malaria Foundation, Global Fund and Government Of Papua New Guinea 12 July to 13 September 2017 Table of Contents Executive Summary .............................................................................................................. 3 Background ........................................................................................................................... 4 Schedule ............................................................................................................................... 6 Methodology .......................................................................................................................... 6 Results .................................................................................................................................10 Conclusions ..........................................................................................................................12 Acknowledgements ..............................................................................................................13 Appendix One – History Of LLIN Distribution In PNG ...........................................................16 Appendix Two – Malaria In Eastern Highlands Compared With Other Provinces .................19 Appendix Three - Malaria By Altitude ...................................................................................21 Appendix Four – Other Photographs ....................................................................................22 Appendix Four - Map Of Eastern Highlands Showing Census Points Of 2000 Census .........24 Annex One Detailed Distribution Data For Goroka District Annex Two Detailed Distribution Data For Lufa District Annex Three Detailed Distribution Data For Henganofi District Annex Four Detailed Distribution Data For Obura Wonenara District Annex Five Detailed Distribution Data For Okapa District 2 Executive Summary Eastern Highlands is a mountainous province of PNG with a few areas which are above 200m which area considered malaria free. There are also some low lying stable malarial areas in the south of the province. A survey and distribution of Long Lasting Insecticidal Nets (LLINs) to family level was carried out in the Eastern Highlands Province between 7 July to 13 September 2017 in the districts of Goroka, Henganofi, Lufa, Okapa and Obura Wonenara. Table One shows the estimated population and actual population found in each district together with the number of LLINs distributed in each district. In total, 215,880 LLINs were distributed to a population of 445,319 people. This resulted in distribution of 48.6 nets for every 100 people in the province. TABLE ONE – Population And Nets Distributed In 2017 Growth Growth House Nets Population Population Nets Rate Rate Holds Distributed Surveyed Surveyed Issued Against Against District Surveyed Per 100 2014 2017 2017 2014 2000 2017 People Survey Census Goroka 134,848 151,123 29,700 72,351 3.87 4.47 47.9 Lufa 64,257 74,733 13,897 36,454 5.16 2.91 48.8 Henganofi 82,528 81,810 17,371 40,228 -0.29 2.28 49.2 OburaWonenara 42,999 50,272 9,457 24,539 5.35 3.15 48.8 Okapa 89,279 87,381 17,685 42,308 -0.71 2.04 48.4 Totals 413,911 445,319 88,110 215,880 2.47 3.10 48.5 A further 1,219 LLINs were donated to health centres as nets were surplus to requirement and in most cases could not be easily returned to a central location. These nets would be used by pregnant mothers and for hospital beds where needed. The overall operational cost of the programme was 710,784.48 Kina (Approximately US$226,990) resulting in a cost of about 3.27 Kina or US$1.04 per net delivered which was about 8% over the anticipated overall budget. There were overspends in car hire due to operations being delayed in some places due to very bad weather combined with bad roads which made some areas periodically inaccessible. This distribution was carried out during the Parliamentary National Elections of 2017 including the period after the elections when other parts of the Highlands became almost inaccessible due to post election violence. Despite this, survey and distribution passed without incident in Eastern Highlands. Feedback from partners and communities suggest they were happy with the methodology used as the process appeared transparent to all concerned. However, as always, there were a few families who complained that they did not receive enough nets but for the most part it is believed that this was a result of families not fully understanding the allocation system used. This distribution of LLINs was funded through a donation of 126,800 nets from the Against Malaria Foundation (AMF) and remainder of the nets being supplied by a donation from the Government of Papua New Guinea. However, all delivery costs of distribution were covered by Global Fund (GF). 3 The history of LLIN distribution in PNG and Eastern Highlands Province is discussed in Appendix One and the malaria situation and stratification of malaria in Eastern Highlands is discussed in Appendix Two and Appendix Three. Fig.1 – Plane delivering nets in Andekombe (left) and Owena (Right) in Obura Wonenara Background Rotarians Against Malaria (RAM) is a nationally based organisation which was formed in 1997 by the Port Moresby Rotary Club in recognition of the tremendous burden that malaria imposes on the people of PNG. RAM has a mandate to work in malaria control and the distribution of LLINs in Papua New Guinea and has been working for many years with the National Department of Health (NDOH) and other partners including bilateral agencies such as UNICEF and WHO (World Health Organisation), NGOs and church groups. (See Appendix One for full history of LLIN Distribution) Fig.2 Planning (Left) followed by Training Of Volunteers in Okapa (Right) Since 2010, RAM has been coordinating the distribution of nets to all districts and provinces on a three-year continuous cycle. This effectively means that RAM visits every village in PNG every three years. RAM is funded by the Global Fund and since 2017 also from Against Malaria Foundation which supplied PNG with all its nets and the Global Fund the distribution and other administration costs. Generally, LLINs have been distributed to household level throughout the country but when shortage of funds have occurred, different strategies of distribution have been used. 4 PNG can be roughly divided into four epidemiological zones. a) Areas which lie above 2000m in altitude will no longer receive LLINs as malaria transmission is not considered possible at these altitudes. b) Low lying areas of the country up to 1200m which have stable malaria endemicity and often have poor access to health continue to have household distributions. c) Areas from 1200 to 1600m which are considered of generally low transmission but may be epidemic in nature. d) Highlands regions between 1600 to 2000m in altitude such as Mount Hagen which have low malaria endemicity and generally easy access to health services. e) In urban and peri-urban areas such as Port Moresby and Lae which lie in low lying areas where access to health is considered easy. As a result of this stratification and when funds had been reduced such as the end of 2014, areas above 2000m no longer received nets and areas from 1600 to 2000m only received under five campaigns in 2015 and 2016. However, due to the introduction of Against Malaria Foundation (AMF) in 2017, all areas now receive household distribution of nets except those above 2000m. Only a few scattered villages of Eastern Highlands lies above 2000m, so therefore in 2017, for practical reasons, all areas in all districts were included for LLIN distribution received household distribution at a rate of approximately one nets for every two people. One of the conditions of the AMF donation is that RAM would strengthen the way in which surveys are carried out. These new innovative processes are described in the Methodology Section a with this methodology now being carried out since the beginning of 2017. The major change to the survey methodology instigated by AMF is that previously a village meeting was called after a survey was carried out where names of family members was read out to ensure that all households had been surveyed. Instead of this process, a summary of every village survey is posted for 24 hours in a public place so that villages can ensure that all their family members have been included in the survey. As a further verification, RAM and local health staff team members carry out random house surveys of 6% of households in every village to ensure that the survey process has been carried out correctly. Fig.3 – Training Of Volunteers In Henganofi (Left) and Okapa (Right) For household distributions, all LLIN distributions regardless of where they are carried out must include a survey and a distribution phase though implementation methods may vary considerably depending on circumstance. RAM’s approach has been to concentrate on quality 5 and develop methodologies that ensure that all recipients in an area actually receive nets and that this can be reported accurately. The other major change to the original PNG programme of 2004 to 2009 carried out by the NDOH is that nets are allocated to families on a needs basis rather than simply the number of people in the
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