Vouchers for scaling up insecticide-treated nets in Tanzania: methods for monitoring and evaluation of a national health system intervention.
BACKGROUND
The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E).


METHODS
A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme.


RESULTS
The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time.


CONCLUSIONS
The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. kara.hanson@lshtm.ac.uk
Kara
K
Hanson
Rose
R
Nathan
Tanya
T
Marchant
Hadji
H
Mponda
Caroline
C
Jones
Jane
J
Bruce
Godlove
G
Stephen
Jo
J
Mulligan
Hassan
H
Mshinda
Joanna Armstrong
JA
Schellenberg
D000818:Animals; D001512:Bedding and Linens / Q000191:economics*; D005260:Female; D006801:Humans; D007306:Insecticides / Q000191:economics*; D033183:Interdisciplinary Communication; D008288:Malaria / Q000517:prevention & control*; D008430:Maternal-Child Health Centers / Q000706:statistics & numerical data; D009032:Mosquito Control / Q000379:methods; D009313:National Health Programs; D011247:Pregnancy; D017064:Process Assessment, Health Care / Q000379:methods; D015397:Program Evaluation / Q000379:methods*; D011632:Public Assistance; D013636:Tanzania
D007306:Insecticides