Tanzania Voucher Scheme–Hati Punguzo – Achievement and Maintenance of Comprehensive Coverage - 22nd Quarter Report, October – December, 2009

The program was launched in October 2004 and aims to boost coverage rates among pregnant women and infants in Tanzania. Pregnant women and infants are most vulnerable to malaria, with pregnancy reducing a woman's immunity to malaria and increasing the risk of illness, severe anemia, and death. Malaria also kills a child somewhere in the world every 30 seconds, mostly children in Africa. To address this challenge, TNVS makes ITNs widely available to pregnant women and infants in Tanzania through vouchers that subsidize the cost of nets at appointed TNVS retailers throughout the country. The voucher system targets sustainability and accessibility by facilitating the distribution of ITNs through a public-private partnership of clinics, wholesalers, and retailers. MEDA is responsible for the logistical coordination of the program and for ensuring availability, accessibility, and affordability of vouchers and ITNs across the country. MEDA has staff members in each region who monitor voucher activity at health clinics and retail shops, recruit and register additional shops into the program, and share information on the unfolding of TNVS on the ground on an ongoing basis. As part of its work, MEDA also works closely with program stakeholders, including local government officials, private organizations, clinic staff, and the private sector. MEDA and its partners have recently rolled out an upgraded Hati Punguzo (HP) voucher, which extends and enhances the current TNVS program. The purposes of the upgraded voucher are to increase the quality of bed nets by switching from an ITN that consists of a polyester net bundled with an insecticide re-treatment kit to an LLIN that comes pre-treated, lasts longer, and does not require retreatment. The upgraded voucher also aims to increase the affordability of bed nets by reducing the top-up amount to be paid by the recipient to a fixed 500. In addition, MoHSW, along with its partners, determined that ITN coverage was not being achieved quickly enough among the important demographic - children under the age of five years - and resulted in a two-prong distribution strategy. One of the strategies to address this challenge is by embarking on a catch-up campaign that would rapidly increase coverage of this vulnerable group to a more desirable 80 percent. The Under-5 Catch-up Campaign (U5CC) is a one-time, free distribution of LLINs program, and MEDA was selected as the logistics contractor for this program. Additional backstopping teams were formed to assist Regional Managers with registration of beneficiaries and issuing of nets for the U5CC rollout across the country. The second strategy involves the provision of an LLIN for every sleeping space in Tanzania captured under the program: Universal Coverage Campaign (UCC). Planning is currently underway for UCC activities that intend to achieve this ambitious and important goal. A pilot of UCC procedures and technologies has been planned for January 2010 in Mwanza Region. The past quarter saw the launch of the LLIN voucher and its subsequent distribution to RCH clinics and beneficiaries across the country. However, a few challenges arose, including the perceived risk of public outcry among recipients of old vouchers who may demand compensation for the upgrade. The number of participating ITN outlets on the mainland remained steady at 6,646, a retailer-to-clinic ratio of 1.50. Under the new LLIN voucher, the manufacturer will be responsible for recruiting and maintaining the retailer and wholesaler network. MEDA launched its new LLIN barcode system designed to mitigate fraud in the TNVS system. The new LLIN voucher reduces the top-up paid by the recipient to TSh 500. This quarter, 562,112 LLINs were distributed to children under 5 in Iringa and Ruvuma regions of Southern Highlands Zone. Registration activities have also been completed in Central Zone and Northern Zone. A pilot program for UCC has been planned for January 2010 in Mwanza and will issue 600 nets across three villages.