Digitalized mass distribution campaign of insecticide-treated nets (ITNs) in the particular context of Covid-19 pandemic in Benin: challenges and lessons learned

Benin’s population is estimated at 12,114,193 inhabitants in 2020 [13]. The country is divided into 77 communes grouped into 34 health zones and 12 departments (Fig. 1). Malaria is endemic in all parts of country with seasonal variations. All of Benin’s population is at risk of malaria infection, which is the leading cause of morbidity and mortality. The incidence of the disease in 2018 was 18.5% in the general population with 1,755,597 confirmed cases of malaria in public health facilities and almost 2,251 deaths due to malaria, most of which are in children under 5 years [14].

As far as the evolution of the COVID-19 pandemic is concerned, Benin recorded its first official case on March 19, 2020 after the enumeration phase. On the eve of the distribution phase, there were 26 official cases with one death. Just after the distribution phase, 64 cases and one death were officially reported. As of November 05, 2020, there are a total of 2781 cases and 43 deaths.

Catholic Relief Services (CRS) gave support to the Government of Benin and the NMCP in digitizing the 2020 ITNs mass campaign. CRS commenced its work with planning and capacity building sessions with NMCP staff. There was training of campaign staff on the use of digital tools and over 27,000 participants at these sessions were digitally-tracked using their biometrics as a mean of validating their attendance to each training session. The digital platform is the Cash-and-Asset Transfer Platform (CAT). A total of 3,382 smartphones and 350 solar chargers were used to perform a household enumeration to register households within the country to obtain a robust population database. It consists during the enumeration phase to collect using smartphones, household information (size, name, gender and age of household members), and then a coupon was assigned to the head of household with a unique Quick Response (QR) Code. The same digital platform was used to track distribution of ITNs and verify that all households registered received the correct number of ITNs allocated to them. The data collected on CAT was available through an online dashboard, updated in real time, allowing field supervisors to make important decisions effectively, and efficiently tracking household coverage rates as households missed were identified using sequencing and geospatial analytical dashboards easily accessible for field supervisors.

Figure 2 shows the different sections and the implementation process of ITNs mass distribution campaign.

External monitoring was carried out by an external firm during the household enumeration. A rapid monitoring was carried out using Lot Quality Assurance Sampling (LQAS).

All of 77 communes were monitored. Monitoring results were shared at time with the actors and supervisors, in order to return to complete enumeration in low coverage areas.

At the national monitor and district supervisor levels, planned field-based activities were reduced in scale. A daily scrutiny of the distribution data uploaded from the smartphones and a virtual meeting each evening allowed supervisors and monitors to focus on problem areas and challenges that could then be addressed and resolved. At the local level, supervisors focused on ensuring that distribution teams adhered to the covid-19 safety measures, as well as ensuring planning and management of the daily team movement plans. Their responsibility included checking the health of distribution team members each day and not allowing them to continue if they showed any covid-19-like symptoms. As yet, results of the local supervision have not been thoroughly analyzed, although anecdotally, it seems that it was quite a challenge for distribution teams to adhere closely to the distancing regulations. In addition, a whatsapp group has been created at the national level, which integrates the actors at different levels in order to resolve the difficulties and situations during the distribution.

The plan for communication included radio and television slots, town announcers and advocacy at every level. Advocacy meetings were completed in advance of the household registration phase, engaging leaders for the entirety of the campaign process. In advance of implementation of the revised strategy, messages were modified slightly to inform about the change of strategy, the new dates and the measures being taken to prevent transmission of COVID-19. As well as radio, television and town announcers, mobile messaging and audio call messages (for the less literate) were used. Community leaders were involved in local mobilization and were asked to be alert to any miscommunication that they heard about ITNs or COVID-19, and to report these to the community supervisor. Following the distribution, communication reinforced the messages passed to households by the distribution teams, i.e. proper airing of new ITNs, use of ITNs, hanging techniques and measures to prevent COVID-19.

A total of 3,175,773 households were registered (more 9.3% from projection) corresponding to a total of 14,423,998 persons (13.55% more from projection) (Table 1). The real ITNs needs are, therefore, known after the enumeration. It was after the household enumeration that ITNs were conveyed to the villages.

Of the 8,609,873 ITNs procured, 7,652,166 were distributed through mass distribution to the beneficiaries. The balance from the procurement was kept to be used for routine distribution. A total of 3,240,259 households were served in the whole country, which corresponds to 93.35% of enumerated households. Moreover, 94.16% (which corresponds to a total of 13,581,637 people) of enumerated population received ITNs during the distribution phase (Table 2).