Can the collection of expired long-lasting insecticidal nets reduce their coverage and use? Sociocultural aspects related to LLIN life cycle management and use in four districts in Madagascar.

BACKGROUND: There is growing awareness of the likely impact increased numbers of LLINs will have on the environment, if not disposed of or recycled appropriately. As part of a World Health Organization (WHO) and United Nations Environment Programme (UNEP) pilot study to assess environmentally-sound and cost-effective LLIN recycling strategies, the USAID-Deliver Project collected 22,559 used bed nets in Madagascar. A social science study was conducted to provide data on socio-cultural factors related to collection and replacement of LLINs, including impact on primary and other net uses. METHODS: Ethnographic exploratory research was carried out following the pilot USAID-Deliver net collection and recycling campaign in Betioky, Tsihombe, Fenerive Est and Ambanja districts of Madagascar, triangulating participant observation, interviewing and group discussions. Sampling was theoretical and data analysis was a continuous and iterative process concurrent to data collection. Final analysis was conducted using NVivo10. RESULTS: The following themes emerged as contributing to the success of collecting expired LLINs in the community for recycling purposes: (i) net adequacy and preference: characteristic differences between collected and newly distributed nets lead to communities' reticence to relinquish old nets before confirming new nets were appropriate for intended use. Where newly distributed nets failed to meet local requirements, this was expected to increase alternative uses and decrease household turn over. (ii) Net collection strategies: the net collection campaign brought net use out of the private sphere and into the public arena. Net owners reported feeling ashamed when presenting damaged nets in public for collection, leading to reduced net relinquishment. (iii) Net lifecycle: communities perceived nets as being individually owned and economic value was attributed both to good-condition nets for sleeping and to worn nets for alternative/secondary purposes. Collecting nets at the stage of waste rather than at their prescribed end of life was locally acceptable. CONCLUSION: The collection of LLINs for recycling/disposal can lead to lower coverage under certain conditions. Collecting used LLINs may be appropriate under the following conditions: (i) nets are collected at the stage of waste; (ii) new nets are in line with community preferences; and (iii) collection strategies have been agreed upon within the community prior to replacement activities. Any collection/recycling of old LLINs should be based on in-depth understanding of the local context and include participatory processes to prevent reduced coverage.

COVID-19 Vaccine Collaborative Supply Planning: Is This the Next Frontier for Routine Immunization Supply Chains?

In response to the COVID-19 pandemic, vaccine manufacturers quickly pivoted to develop vaccines, offering limited visibility into production timelines and quantities. Low- and middle-income countries developed vaccine introduction plans within the context of constrained global supply, unknown vaccine availability or timelines, and unknown demand. The Vaccine Collaborative Supply Planning (VCSP) Initiative was established to address the gaps in visibility of supply and demand of COVID-19 vaccines for improved supply planning. The Initiative drew from experiences with supply planning for other health program products. The Initiative's 2 goals for introducing COVID-19 vaccines were to: (1) incorporate the use of supply chain data for forecasting, supply planning, and resupply decisions; and (2) establish a collaborative model for governments and partners to learn and implement. Beginning in September 2021, the Initiative was operational in 15 countries through strategic partnerships with government immunization programs and 7 partnering organizations. Partners noted the Initiative offered several benefits: enabled visibility into stock status; provided ability to triangulate service delivery and stock data; provided insight into products at risk of expiry; facilitated tracking of monthly consumption patterns to inform decisions; offered ability to create forecasting scenarios; provided support to national logistics working groups; improved coordination at the country level; created trust through transparency across global partners; and offered opportunity for real-time adjustments through adaptive learning. Partners also noted challenges, including the influence of political decisions and the availability of quality data. The Initiative successfully applied best practices for supply planning, established a collaborative model with government decision-makers and partners, and used an adaptive learning approach to respond to the challenges of rolling out the COVID-19 vaccine. Lessons learned and recommendations suggest how this approach can be used to strengthen forecasting and supply planning for all vaccines as the COVID-19 vaccine is integrated into routine services.