Evaluation Of The Insecticide Treated Bednet Project In The Builsa District Of The Upper Region Of Ghana

ABSTRACT Builsa District is the largest of the six (6) districts in the Upper East Region with a population of 75,072 people. Malaria has been one of their major problems of public health importance as noticed nation wide. The incidence of malaria was found to be 290 per 100,000 population and accounted for about 48% of all OPD attendances and about 42% of admissions in the Builsa District for over a period of five (5) years. The bed net programme is being promoted in the Upper East Region and Builsa is one of the districts where UNICEF introduced the programme in 15 pilot VAP communities in 1999 under the Integrated Community Based Development Programme. This study was conducted to determine the extent of effective use of the bednet in the district and factors that affect the smooth implementation and failure of the project in the district, the communities’ knowledge on causes and prevention of malaria, factors that affect the acquisition of the ITNs and retreatment. A descriptive, cross-sectional study using both qualitative and quantitative methods for data collection and analysis was done. Structured survey questionnaires, In-depth and Key Informant interviews were used. Three hundred (300) respondents were interviewed from the fifteen (15) VAP communities which were in the programme since 1999. Fifty (50) new communities were added at the time data collection was started. About 86% of the respondents know of malaria and its prevention, willingness to acquire the bed nets is about 96% but only 30% were willing to pay 13,000 cedis ix outright for the nets. 78.9% of the pregnant women and 34% of children under 5 years sleep under the nets where available. 54% of the respondents know that the bed nets should always be used once acquired. About 72% of the bed nets were clean and hung but not retreated. Monitoring, records keeping, intersectoral collaboration, the communities’ attitude, the sales agents, and the mode of payment were identified as factors that affected the smooth implementation and sustainability of the programme. There were shortages of insecticide in 8 out of 12 months in a year in the district. Monitoring was poor as a result of lack of logistics and motivation. The sales agents were not selected by their communities, had no guarantors, and were not trained for the project at the Navrongo Research Centre as planned. Sales agents were not accounting for sales made regularly. The community members were either not paying regularly or not at all. There was lack of cohesive collaboration between the District Assembly and the District Health Management Team. Sales agents should be properly identified by their communities and should have credible guarantors.The sales agents and the sub-district coordinators should be financially motivated. A coordinated intersectoral collaboration between the health sector and the District Assembly for the close monitoring of the project regularly. The Bed net Project account should be separated from the Integrated Community Based Development Programme common fund.