Foster Partnerships Between Textile, Insecticide, Technology Firms

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Foster Partnerships Between Textile, Insecticide, Technology Firms

  1. 1. WIN Monitoring & Evaluation M & E Issues <ul><li>What’ s New in M&E ? </li></ul><ul><li>Develop Measures, Indicators and Tools </li></ul><ul><ul><li>New Document on M&E Capacity Strengthening from MERG </li></ul></ul><ul><ul><li>GFATM toolkit </li></ul></ul><ul><li>Populations at Risk </li></ul><ul><ul><li>Forest Malaria SE Asia </li></ul></ul><ul><ul><li>Epidemic & peri-urban areas in Africa </li></ul></ul><ul><ul><li>Elsewhere? </li></ul></ul>
  2. 2. Household Surveys for ITN outcomes <ul><li>DHS and MICs </li></ul><ul><li>Nationally representative but infrequent </li></ul><ul><li>Not primarily designed or intended for ITN-specific M&E questions </li></ul><ul><li>Not easy to influence </li></ul><ul><li>What surveys can do </li></ul><ul><li>Basic coverage – who uses which net? </li></ul><ul><li>Net history & source (all nets should be marked - are they?) </li></ul><ul><li>Which nets cover which people? </li></ul><ul><li>More nets = more use? </li></ul>
  3. 4. Timing Issues – Work Needed Here !! <ul><li>Dry season vs Wet season – DHS vs DSS ? </li></ul><ul><ul><li>Extended risk at end of rains </li></ul></ul><ul><li>Coverage during most vulnerable times – </li></ul><ul><ul><li>Standard Denominator is ALL U5s !! </li></ul></ul><ul><ul><li>4 to 24 months in most intense areas? </li></ul></ul><ul><ul><li>8 to 48 hours in moderate intensity? </li></ul></ul><ul><ul><li>Malaria in Pregnancy – is ANC too late? </li></ul></ul><ul><ul><li>Avoidance during pregnancy? </li></ul></ul><ul><li>Usage behaviour within the family (SE Asia) </li></ul><ul><ul><li>Are ITNs preferred? </li></ul></ul><ul><ul><li>Give new ITNs or treat untreated nets? </li></ul></ul><ul><li>Campaigns vs Routine delivery </li></ul><ul><ul><li>Covering kids born between campaigns, ANC vs EPI, etc </li></ul></ul><ul><li>Net Life and Duration of protection…. ITN, LLIN, untreated nets, net types </li></ul>
  4. 5. Programme Issues <ul><li>Costing Framework </li></ul><ul><li>Sustainability </li></ul><ul><li>Indicators of Supply Constraints </li></ul><ul><li>Effectiveness of Targeted Partial coverage </li></ul><ul><ul><li>Mass effect is NOT saturated with ITNs </li></ul></ul><ul><ul><li>modelling </li></ul></ul><ul><li>IRS vs ITNs vs other vector control measures </li></ul><ul><ul><li>Difficulties / biases in comparing IRS vs ITNs </li></ul></ul><ul><ul><li>Short-term effectiveness vs coverage </li></ul></ul><ul><ul><li>Mass effect vs personal protection </li></ul></ul><ul><ul><li>Size of randomisation unit </li></ul></ul>
  5. 6. How surveys can inform programmes An example from SE Asia
  6. 7. <ul><li>Malaria IS a disease of Poverty in Cambodia !! </li></ul>8420 1700 1705 1653 1677 1685 Total Number 266 7 21 45 61 132 Number positive 2.7 0.4 1.1 3.7 3.3 7.4 % positive Total 5 4 3 2 1 Quintile Slide result
  7. 8. Where is the nearest place to buy a bednet ? Where would you go to get your net treated? 3204 1 1 7 71 19 % % % % % N Don’t know Not buy / other Further away At local market Nearer than local market 3202 68 1 1 4 27 % % % % % N Don’t know Don’t want Shop market pharmacy Go to health centre Wait for health / project staff
  8. 9. Net and ITN Coverage Almost everyone is sleeping under a net, yet only 37% of HH are officially characterised as owning sufficient nets (<2.3 people per net). RECOMMENDATION: The current definition of sufficient doesn’t work, and is too stringent. It should be higher. The exact figure should be set according to the data, not arbitrarily. Changing the target ratio to 2.0 or 1.5 would make the problem worse. 7 % 37 % % HH with “sufficient” (2.3) 13 % 86 % % PW sleep under 20 % 87 % % U5 sleep under 20 % 84 % % people sleep under 25 % 96 % % HH owning >=1 ITNs Nets
  9. 10. Net and ITN Coverage * These people are potential converts to ITN-use through re-treatment campaigns ** These people are potential converts to ITN-use through free ITN distribution 14 % 16 % 20 % 15 % 13 % No net ** 13 % 19 % 18 % 21 % 20 % Fresh ITN 18% 16 % 16 % 17 % 19 % Expired ITN* 55 % 49 % 46 % 47 % 48 % Never treated net * Preg F 15+ F 15+ M 5-14 <5
  10. 11. Conclusion: both questions are being answered fairly accurately “ Has this net been treated ?” How reliable are responses that nets have / have not been treated? 19 % 80 % Government / NGO / Project N = 686 82 % 18 % Commercial / Market / Shop N = 2026 No Yes Has the net ever been soaked with insecticide? Source of Net
  11. 12. Coverage is constant over all sub-groups – but the proportion of nets obtained from the government IS much higher in risk-zones prioritised for ITN distribution 411 920 2913 2517 15831 N 6 % 14 % 42 % 37 % 84 % Overall 7 % 14 % 57 % 21 % 79 % 1 – 2 km 7 % 17 % 37 % 36 % 87 % 0.25 – 1 km 6 % 12 % 36 % 47 % 86 % 0 – 0.25 km Gift Don’t know Itinerant seller Market Shop Gov’t NGO Project Where did your nets come from? % of people sleeping under a net Distance from Forest
  12. 13. Technical Issues <ul><li>Situation </li></ul><ul><ul><li>Current Technology good but not ideal </li></ul></ul><ul><ul><li>Rapidly evolving technical developments </li></ul></ul><ul><ul><li>Current LLIN Production Capacity Inadequate </li></ul></ul><ul><ul><li>Some critical and widely shared obstacles and barriers </li></ul></ul><ul><ul><li>New Opportunities for donor support </li></ul></ul><ul><li>Goals - </li></ul><ul><ul><li>Foster expansion of capacity of existing technologies </li></ul></ul><ul><ul><li>Foster market entry by new producers </li></ul></ul><ul><ul><li>Accelerate development of technologies </li></ul></ul>
  13. 14. Key Obstacles - 1. Access to Data <ul><li>Access to Existing Information </li></ul><ul><ul><li>Knowledge of basic technical options in relation to costs, existing equipment, etc (e.g. if you have weaving, not warp-knitting, machines) </li></ul></ul><ul><ul><li>Foster Partnerships between textile / insecticide/ technology firms </li></ul></ul><ul><ul><li>Promote access to textile & additive technology expertise </li></ul></ul><ul><ul><li>Demand forecasts …. </li></ul></ul><ul><ul><li>Price elasticity </li></ul></ul><ul><li>Cost of (and capacity for) R & D </li></ul><ul><ul><li>Support “immature” research – no IPR </li></ul></ul><ul><ul><li>Support testing during development – IPR protected </li></ul></ul><ul><ul><li>Support testing after development – IPR secured </li></ul></ul><ul><ul><li>[ Support WHOPES / registration data collection ] </li></ul></ul><ul><li>Public/shared research issues – e.g. Resistance, Market Research </li></ul>
  14. 15. A “Technology Trust ?” <ul><li>Brokering private-private and public-private partnerships </li></ul><ul><li>Fostering access to public domain information </li></ul><ul><li>Offering subsidised access to testing and other tech support for candidate products - confidential </li></ul><ul><li>Other R&D support ? (IPR issues) </li></ul><ul><li>Independent testing of market-ready products ? </li></ul><ul><li>Support for WHOPES process </li></ul>
  15. 16. 2. WHOPES Registration Issues <ul><li>Costly </li></ul><ul><li>Slow – and this is, to some extent inevitable !!! </li></ul><ul><li>We have standard tests and wash-wear methods, BUT </li></ul><ul><ul><ul><li>Limited replicability – need to test in multiple centres </li></ul></ul></ul><ul><ul><ul><li>Little knowledge of factors affecting durability in the field – and how to mimic with lab processes </li></ul></ul></ul><ul><ul><ul><li>How well do current entomological tests and criteria represent field performance? </li></ul></ul></ul><ul><ul><ul><li>Some products are more LL than others! </li></ul></ul></ul><ul><li>Further Development of Standardised (and simplified) laboratory methods and definitions </li></ul><ul><li>Get candidate products into the field early ! </li></ul><ul><ul><li>Don’t wait for Phase I / II data Experimental registration and existing tox data for established insecticides </li></ul></ul><ul><li>Working Party planned for these issues </li></ul>
  16. 17. 3. Country Registration Issues <ul><li>Widely perceived as a critical barrier, </li></ul><ul><li>clear evidence for importance in practice … even for existing products !! </li></ul><ul><li>Currently, EVERY product must be tested in (nearly) EVERY country </li></ul><ul><li>Key issue is efficacy data </li></ul><ul><li>Urgent need to break this log-jam!!! </li></ul><ul><li>Must maintain Quality Standards and Safety </li></ul><ul><li>Cannot revise entire registration system – mainly for agricultural products – need to treat LLINs as exceptional case </li></ul><ul><li>National Bureaux of Standards – Another burden / pitfall </li></ul><ul><li>Need for Vigorous and Urgent Action at regional and country level </li></ul><ul><li>more vigorous country-specific lobbying by RBM and Partners </li></ul><ul><li>Harmonise processes at regional / sub-regional level </li></ul><ul><li>Remove need for country-specific registration data </li></ul><ul><li>Role for African Union / NEPAD via MoH ??? </li></ul>
  17. 18. Quality Control <ul><li>Post-registration QC of final market product </li></ul><ul><li>IPR-breaking Copies: will they find a procurement market? </li></ul><ul><li>Health & Safety in Production - GMP </li></ul><ul><li>Risk assessments for new technologies… </li></ul><ul><li>Need for clear standards (see above) </li></ul><ul><li>Standards/specifications for new technologies </li></ul><ul><li>Standardising claims… (years, washes, etc) </li></ul><ul><li>Costs vs QC – level playing field </li></ul>
  18. 19. Financing <ul><li>Forecasting – but must be convincing </li></ul><ul><ul><li>Consistent </li></ul></ul><ul><ul><li>Donor commitment </li></ul></ul><ul><li>Market segments – local distribution vs procurement </li></ul><ul><li>“ Will Donors pay the Difference ??” </li></ul><ul><li>Which is better ??? </li></ul><ul><ul><li>guaranteed purchases </li></ul></ul><ul><ul><li>Equity </li></ul></ul><ul><ul><li>Loans </li></ul></ul><ul><ul><li>Risk sharing…. </li></ul></ul><ul><li>Financing Vehicles </li></ul><ul><ul><li>Acumen fund </li></ul></ul><ul><ul><li>Others ?? Need for a specific mechanism? </li></ul></ul>
  19. 20. Regional Centres ??? <ul><li>A public sector body </li></ul><ul><li>Regional/sub-regional testing & evaluation of market-ready products for registration – incl. packaging etc </li></ul><ul><li>QC of products already on market </li></ul><ul><li>National Registration Officers sit on Board </li></ul><ul><li>Testing by local laboratories </li></ul>
  20. 21. Licensing Issues <ul><li>E.g. in tech transfer – competition between owner and licensee </li></ul>
  21. 22. Suggestions… <ul><li>“ Technology Trust” – </li></ul><ul><ul><li>as information broker and midwife for infant technologies and products </li></ul></ul><ul><ul><li>Subsidised testing / tech support </li></ul></ul><ul><ul><li>Market information </li></ul></ul><ul><li>Regional/Sub-regional Centres for </li></ul><ul><ul><li>registration and </li></ul></ul><ul><ul><li>QC (and continued evaluation?) - </li></ul></ul><ul><ul><li>NEPAD ? </li></ul></ul><ul><li>Financing for production – mechanism(s) needed </li></ul>

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