2nd Round School-based LLIN Distribution in Cross Rivers State - 9th May, 2013

Key Findings from Obubra and Ogoja LGAs

OBSERVATIONS* / RECOMMENDATIONS AND NEXT STEPS
QUANTIFICATION
For the most part, there appeared to be sufficient nets except for some small changes in the number of students. A handful of schools visited by supervisors had a surplus of nets ranging from three to sixteen, while other schools had a shortage of nets ranging from seven to forty-nine. There were a few reasons for these:
a)During microplanning, some heads of schools did not include the students who had not yet paid school fees.
b)Some schools continued to admit students after the microplanning session.
c)In Obubra LGA, some “illegal” schools had been closed down, and the students were transferred to the government schools. The executive secretary assured us this was a one-time event.
In addition, there was a lot of misunderstanding regarding the nets for teachers. A lot of principals and supervisors did not understand that the nets delivered to the schools included nets for the teachers of the targeted classes. When we were calculating shortfalls, they kept adding nets for teachers, even though the quantification had already factored it in. In truth, they only needed to add the new students. / a)The LGA education secretaries are compiling lists of schools with surpluses and shortfalls. Supervisors will redistribute surplus nets to schools with shortfalls when they do their supervision visits. The students who did not receive a net will get a net next year.
b)Add a buffer stock. Last year we did not have one and came up around 80 nets short due to new registrations. This year we had a buffer stock of 100 nets. Once we get the list from the education secretaries, we will get a better sense of the buffer we will need for next year.
c)The education secretaries will include the issue of quantification in their next monthly meeting, which is on May 14. They should remind heads of schools that ALL students should be counted, regardless of whether or not they have paid school fees. These are the students who are most vulnerable; they are least likely to be able to purchase nets or afford treatment.
d)Heads of schools will be reminded that shortfalls understandably occur when new registrations occur after the micro-planning, that these need to be calculated (and not be seen as a big emotional issue) and that provisions will be made for these new admissions (e.g. buffer)
e)The LGA Executive secretaries to inform school heads to declare correct/actual enrolment figures.
TIMING AND DURATION
This year’s distribution took place during the second week of the third term. Some schools did not start their distribution at the agreed upon time. Some mistakenly waited for supervisors to arrive before distributing nets. Other schools started distributing on day 2 (which was supposed to be the mop-up day) or on day 3 (which was a Monday and thus the nets would have sat in storage over the weekend).Some secondary schools did not have many students because they help out with farming at home during the first couple of weeks of the current season and many had not yet come back. It is also possible that some heads of schools were distracted because the senior secondary students were writing their exams. / In consultation with the Executive Secretaries and upon reviewing the school calendar, we agreed to hold the final round of distribution in late February and the micro-planning meeting in the first week of February next year in order to avoid attendance issues due to the agrarian activities and the distractions caused by exams.
The Executive Secretaries will emphasize to the heads of schools the importance of starting at the intended time, which was chosen so as not to disrupt school activities and to minimize the amount of time that nets are in storage at the schools and thus the risk of being stolen.
LOGISTICS
Notably, there were no reports of nets having gone missing or deviances between the number of students in the microplan and the number of nets delivered. “Shortfalls” were more likely to be due to the number of new students. / Nets should be delivered to the head of schools and not on weekends.
STAFFING
There was confusion regarding incentives for teachers. Most heads of schools and even supervisors did not realize that nets would be given to all teachers, not just the ones from the targeted classes. One secondary school head also complained about the lack of incentive; he wanted more money for his role (ex: more than the 500 naira they received for transportation). The supervisors explained that this was a one-off activity, and that he should be glad that his school and his LGA was fortunate enough to be a part of it, since other LGAs were not getting new nets, and that government staff were expected to contribute to the effort, given that the nets were already contributed by USAID. The supervisors were very keen to educate this person because he is the secretary of the association for school principals and thus may be an opinion leader for heads of schools. / Instead of delivering nets for just the targeted classes’ teachers, we should keepall the nets for all the teachers at the same place (in the school
Include the leadership of All Nigerian Conference of Principals of Secondary Schools (ANCOPSS), All Primary Schools Head of Nigeria(APSHON), Nigeria Union of Teachers (NUT), National Community Health Practitioners of Nigeria (NCPH) , Chairman, State PTA, Chairman and Supervisors for Health and Educations in both LGAs, at the planning meetings and trainings and dissemination meetings.
SUPERVISION
The motivation and organizational skills of heads of schools are key to the success of each school’s distribution activity. When the heads of schools understood the process and was inclined to follow it, the distribution went as planned. When this was not the case, the distribution was more likely to start late, or net packages would not be opened, etc.
Primary schools were most likely to perform well. They were more likely to have invested some creative efforts into communicating about malaria and more likely to have conducted the activity on the day and time assigned. Secondary schools and urban schools were less likely to perform as well as the primary schools. They were much less likely to have done the distribution at the assigned day and time. It is possible that primary schools were more likely to consider the activity as a priority for their students, while secondary school students are seen as a lower priority audience. In addition, secondary schools had exams for the senior year students and thus may have had some competing priorities on the day of distribution.
Before the supervision teams left to supervise the distribution, we all met to divide up the schools and review what to look out for. However, there was no written tool for supervision, so the quality of the supervision really depended on how well the lead supervisor explained the exercise, how well the supervisor took notes, and the initiative of each supervisor. Not all supervisors observed the same things. For example, some went the extra mile to check registers and waybills and others didn’t. Some supervision teams stayed together so if there were multiple classes distributing at the same time in the same school, all the supervisors would be watching the same class instead of being spread out across the classes. / Consider providing heads of schools with a tool or checklist for pre-during-and post distribution to clarify expectations, particularly since the majority of schools cannot be visited by a monitor/supervisor.
Emphasize to secondary school heads that the age of the students does not matter. The true target audience for this are the households. Thus, secondary school students are a means of getting nets to homes, and their families will decide who will have priority for using the net, not the school. The families may prioritize their pregnant household members, small children, or even adolescents or adults. Delays or errors in distributing nets through secondary schools creates access issues for families in their communities.
As described above, next year’s round will try to factor in the timing of the exams (as they should have this year). In addition, heads of secondary schools or schools with competing priorities during the week of distribution should consider assigning a focal person for the distribution if they cannot attend to the distribution properly.
Provide supervisors with the same pre-during-and post distribution standard tool that the heads of schools would use. Samples of supervision tools are in the AMP toolkit and can be adapted. Supervisors should try to be spread out and support as many teachers as possible whenever they are in the same school.
COMMUNICATION
During the trainings the schools were advised to do at least one activity from the teacher’s guide prior to distribution. Because the guide was intended to give teachers’ flexibility, we did not expect a high level of standardization. However, it was not clear what schools had done or were planning to do. We did not see principals or teachers using the teacher’s guide at the time of distribution (but they weren’t using any supervision or implementation tools either, other than the distribution registers). Some primary schools created their own malaria songs which could be disseminated, and some schools also taught about malaria. PTA meetings did occur in some of the schools (although attendance was low, as expected) and informational visits to ward development committees and traditional leaders took place. Since the distribution took place during a Thursday and Friday, we did not get the chance to put together a focus group of heads of schools or teachers since we had to leave that weekend.
Environmental interventions are still taught heavily at the schools. Unless prompted, the teachers or principals did not teach about net care and repair. Interestingly, one of the Roll Back Malaria focal persons and social mobilization officers said that CHWs and JHWs can visit households who received nets to promote use and hanging, as well as sharing nets. They also said that malaria messages are being disseminated through group meetings at health facilities and through radio (not about schools though). / a)Teachers and heads of schools to fill out their communication action plan. The plan is intended to help teachers figure out what activities they will do before, during and after distribution. If there is routine school monitoring visits, school inspectors can do spot checks to see if these action plans are being completed.
b)The ACSM strategy includes in-school programs and the NMCP has created materials for teaching students about malaria. These materials are helpful because they address both treatment and case management. There is a booklet for primary school students and another booklet for secondary school students. However, they are out of date and need to be harmonized with the ACSM strategy since, for example, they include environmental interventions and nothing about testing. Moreover, nobody knows (and thus it is unlikely) whether schools are even using these materials. Thus the ASCM committees, the Special Advisor for Health and the Education Commissioner will need to come to agreement on whether they do want to a) update these materials and b) produce and scale up their use in schools. Finally, the materials I saw are comic books for primary school children, so there may be a need for some supplementary material for teachers to help them plan on how to use the booklets to teach about malaria. The ASCM committees and above individuals may find it useful to review and adapt the teacher’s guide accordingly. It may be worthwhile to consider testing the existing materials with teachers to further identify areas for improvement.
c)The social mobilization officers of both LGAs said that CHWs and JHWs can conduct follow-up visits to help make sure the nets are hanging and being used. I think this can help reach parents. Ideally radio programs are also talking about net use, etc.
d)Schools to keep record of their activities, it will help for continuity when a teacher is posted out and a certificate of commendation is issued to the outgoing teacher.
e)Document and disseminate the songs and activities developed by teachers (this creative initiative was more pronounced in the primary schools). Conduct some group discussions to learn which methods work best for the teachers and promote them.
f)Invite NMCP representatives from ACSM and IVM braches to participate at the dissemination and other activities

*These are not comprehensive results. They are based on supervision visits and debriefings with supervisors at Obubra and Ogoja LGAswhich were conducted during the two days of the distribution.

NEXT STEPS

  1. May 14, 2013, meeting of heads of schools will include the school net distribution into their agenda
  2. Health sector officials to attend
  3. ANCOPSS and other head of school association leaders to attend
  4. Agenda to cover the following: Lessons Learned, Good Practices, Suggestions for how to sustain and improve this activity. In addition, the following should be addressed:
  5. Non-exclusion of students who have paid school fees.
  6. Clarifications that all teachers are expected to teach about malaria, and thus all teachers also receive nets as acknowledgement of their role in preventing malaria in their communities.
  7. Importance of conducting follow-up sensitization and education about malaria, and helping teachers develop an action plan.
  8. Clarification that shortfalls are only due to new admissions, and what provisions are made for these.
  9. The importance of doing the distribution at the intended time.
  10. Heads of schools to submit data about shortfalls and surpluses to help with calculating buffer stock using class register
  11. MOE, MOH, and IPs to discuss communication plan and supervision tools so that any needed materials and job aids are developed by the micro-planning meeting in early February.
  12. Health and Education sectors to invite each other during State and LGA monthly meetings
  13. 3rd Round micro planning starts Monday, 3rd February, 2014
  14. Finalized enrolment list of all schools by targeted classes (Pry 1, Pry 4, JS1 and SS1) by ward
  15. Names of head of schools and their contact
  16. Training of teachers by zones in cluster
  17. Table showing details for data submission – format

S/n / Ward / name of school / Name of head school / Phone number / Type of school / Class e.g Pry 1a / Number of Pupils/students / Number of teachers / Total No of nets needed by school