A voucher scheme for insectide treated nets in Ghana: development of a methodology for delivery systems evaluation

The key to effective scaling-up of coverage with insecticide treated nets is multiple effective delivery systems that are complementary, each one adding incrementally to the overall coverage. Generally, individual systems have been studied. A methodology is needed for studying the effectiveness of individual delivery systems, mixes of delivery systems and their relative contribution to coverage within a defined delivery system context. The insecticide treated net voucher scheme in two regions of Ghana provided an opportunity to develop a method of delivery systems evaluation. The thesis consists of eight chapters. Chapter one is the introduction, and chapter two a review of the literature on the delivery of ITNs. Chapter three presents the study justification, aim, objectives, conceptual framework, a description of the study setting and the methods used in the study. The thesis has four results chapters. In the first of these the quantitative coverage outcome evaluation of the voucher scheme is presented. Delivery attribution is used to evaluate the success of the voucher scheme. In the second results chapter, the intermediate processes in the delivery system are defined and the effectiveness of each one is assessed overall and by geographic area and socio-economic groups. In the third results chapter, qualitative methods are used to interpret the quantitative findings and to describe and explain the impact of the delivery systems context on the effectiveness of the intermediate processes of the voucher scheme. In the fourth of the results chapters' recommendations on a methodology of delivery system evaluation for ITNs and other public health interventions are made. The final chapter is a discussion of the findings of the study in the two regions of Ghana and their implications for the evaluation of delivery systems for ITNs and other public health interventions particularly in relation to malaria control.