Improving the Effectiveness of Long-lasting Insecticide-treated Net (LLIN) Campaigns in Ghana

Research Project

Improving the Effectiveness of Long-lasting Insecticide-treated Net (LLIN) Campaigns in Ghana

Strengthening the use of LLINs through the Community-Based Health Planning and Service Programme (CHPS)

Summary

A stakeholder and community-based intervention to transition the mass LLIN distribution campaigns to the Community-based Health Planning and Services (CHPS) Programme, and improve the use of LLNs in Ghana.

Ghana

Study sites included six communities across two regions (Eastern and Volta) in southern Ghana

Malaria

Promising Practices

Develop a manual to guide the preparation, use, and maintenance of LLINs and key misconceptions within communities.
Leverage the presence of community services in the communities to advance the mass LLIN distribution campaigns.
Integrate a community advocacy team into the existing community health committees.
See more.

Key Messages

The University of Ghana and Ghana Health Service assessed LLLIN campaign implementation and identified potential enablers and barriers to determine if the Community-based Health Planning and Services Programme (CHPS) could support the implementation of mass LLIN distribution campaigns and improve the use of LLINs. An intervention called CHAT (Community Health Advocacy Team), a nine-member team of community actors, was formed to plan and lead social and behavioral change communication (SBCC) activities on regular LLIN use within communities. Key findings:

The National Malaria Control Programme (NMCP) rolls out mass long-lasting insecticide net (LLIN) distribution campaigns in communities. However, LLINs have not always been effectively used or embedded into the primary healthcare structures.
A community health advocacy team should be constituted to support the LLIN distribution campaign in communities.
The LLIN distribution campaign would be transitioned into the community-based health planning and services programme (CHPS), improve the use of LLIN within communities, thereby reducing malaria morbidity and mortality.

Background

Context

Long-lasting Insecticide-treated nets (LLIN) have been identified by the World Health Organization (WHO) as an effective approach for malaria prevention (WHO, 2017).
In Ghana, the Mass LLIN Distribution Campaign seeks to protect at least 80% of the population at risk with effective malaria prevention interventions, through household registration (90%) and distribution (90%) in target regions, by adopting WHO’s universal health coverage policy (UNICEF/WHO, 2015).
In spite of the progress made in overall LLIN ownership over the years, the challenge remains to reach the target of 80% utilization among pregnant women and children under 5 years as outlined in the NMCP Strategic Plan. The gap between access to and use of LLINs in Ghana is high.
Though these campaigns expose high proportions of the Ghanaian community to LLIN interventions, they do not always lead to desired health-related behaviors (i.e., LLIN use).
Ghana adopted the Community-based Health Planning and Services Program (CHPS) as a primary healthcare system in 2005 to ensure accessible and equitable health services. The CHPS concept involves the provision of door-to-door primary health care services to community members by trained nurses known as community health officers (CHOs) and has proven to be successful in providing maternal, reproductive and child health services in communities where they are much-needed.
Despite the established structure of CHPS in enhancing community involvement and ownership of primary health care in Ghana, the distribution of LLINs is not well-integrated into the CHPS structures. To ensure sustainability and continuous community engagement through SBCC activities on regular use of LLINs, there is the need to transition the Mass Distribution Campaign into the CHPS programme. This would help reduce the overall gap between access and use of LLINs and achieve the desired health-related behaviors.

Image above: Community Health Advocacy Team (CHAT) members on home visits, creating awareness on malaria prevention and LLIN use.

Study Objectives

Assess the LLINs campaign implementation processes at the community level to identify stages involved in the delivery of LLINs by end of August, 2021.
Identify potential enablers and barriers within the Community-based Health Panning and Services Programme (CHPS) to determine institutional structures that can be leveraged/addressed to support the implementation of continuous mass LLIN distribution campaigns to improve use of LLINs by end of August, 2021.
Prioritize contextual factors and implementation processes for effective campaign transitioning to increase household use of LLINs through stakeholder engagement, by end of September, 2021.
Co-create interventions (i.e., capacity building for community health officers, community mobilization) to strengthen the mass LLIN distribution campaign, by the end of October 2021, to increase use of LLINs within households.
Assess the acceptability and appropriateness of co-created campaign interventions (i.e. capacity building for community health officers, community mobilization) through the conduct of community surveys and interviews by end of February, 2022.
Assess the feasibility of transitioning the co-created interventions (i.e. capacity building for CHOs, community mobilization) into primary healthcare delivery through the conduct of key informant interviews among health care workers by end of May 2022.

See the slides for detail on the methods of the study.

Results

Summary

Though the majority of households receive LLINs for free mainly through mass distribution campaigns, the distribution of LLINs without Social and Behavioural Change Communication (SBCC) activities make beneficiaries less likely to use LLINs to reduce the transmission of malaria.
Although some community members (i. e. traditional authorities, volunteers, etc.) are engaged to support the campaign, local structures are not fully optimized to effectively address misconceptions and misunderstandings surrounding LLINs within communities and such misconceptions linger within communities to drive the non and misuse of LLINs.
Community receptiveness to Community-based Health Planning and Services Programme (CHPS), language and cultural competencies of community health workers and awareness creation on health-related activities within the CHPs system can be leveraged.
Potential barriers can be addressed to support the implementation of continuous Mass LLIN Distribution Campaigns to improve the use of LLINs.

The co-created intervention CHAT (Community Health Advocacy Team) constitutes significant actors within the study communities whose roles include awareness creation on LLIN use and malaria prevention, community/social mobilization, capacity building and social and behavioral change communication (SBCC).
After successful implementation of the intervention, the majority (90%) of community members in all six districts perceive the CHAT intervention to be acceptable, appropriate and feasible.

Professor Phyllis Dako-Gyeke, University of Ghana, walks through the objectives, methods, lessons and policy implications.

Lessons Learned

Reflecting on lessons learned and feedback received from participants in the feasibility survey, these promising practices were developed and should be pursued in future health campaigns and integration research.

Develop a manual to guide the preparation, use, and maintenance of LLINs and key misconceptions within communities.
Leverage the presence of community services in the communities to advance the mass LLIN distribution campaigns.
Integrate a community advocacy team into the existing community health committees.

In addition, see the research brief for lessons learned and implications for policy and future research.

Research Project