Nigeria Malaria Impact Evaluation

1. Launching the Malaria Impact Evaluation Program Nigeria Malaria Impact Evaluation Claribel Abam Festus Okoh Ramesh Govindaraj Joe Valadez Iris Boutros Sebastian Martinez

2. Intervention • Scale up of the coverage and use of LLITNs, ACT, IPT and IRS in seven program states • Innovative demand and supply side approaches, with the objective of reaching 80% use of ITNs by vulnerable group by 2010. • The impact evaluation design was focused on two areas of primary importance: • Delivery of LLITNs and ACT through private sector • Ways of improving the implementation and performance of the alternative delivery mechanisms. • Ways of improving coverage and use of LLITNs and ACT on the demand side • Focus on • PMV (Patent Medicine Vendors) • RMM (Role Model Mothers) /TBA (Traditional Birth Assistant) • CHW (Community Health Worker) /VHW (Village Health Worker)

3. Supply Side Policy Questions: • National Level (7 program states): • What is the effect of delivery of LLITNs and ACT through the private sector (PMVs) on coverage and usage of LLITNs and effective anti-malarial treatment? • Pilot Schemes: • What is the marginal effect of alternative incentive schemes on the performance of PMVs? • What is the marginal effect of follow-up/ongoing training on the performance of PMVs?

4. Demand Side Policy Questions: • National Level (7 program states): • What is the effect of Role Model Mothers (RMM) on the coverage/use of LLITNs and effective anti-malarial treatment? • Pilot Schemes: • What is the effect of alternative incentive schemes to RMMs, TBAs and CHWs on the coverage and usage of LLITNs and effective anti-malarial treatment? • What is the effect of follow-up/ongoing training to RMMs, TBAs and CHWs on the coverage and usage of LLITNs and effective anti-malarial treatment?

5. Indicators • coverage of LLITNs • use of LLITNs • use of ACTs • fever • other maternal and child health outcomes • socio-economic outcomes (labor supply, income/consumption, schooling, etc)

6. Evaluation Design - National • Incorporation of PMVs and RMM through LGA level training activities over a 9-12 month period. • Random roll out of training activities amongst LGAs across 7 project states • Exogenous variation in the presence of PMVs/RMM (6-9 month exposure) • Exogenous variation in exposure to treatment thereafter • LGAs trained first constitute the treatment group • LGAs trained last constitute the control group. • Consider opportunities for randomizing at Ward level. • Roll out of training activities commence by June 2007.

7. Evaluation Design – Pilot Studies • Representative sample of evaluation communities or villages: • Random assignment of incentives to PMVs • Random assignment of training to PMVs • Random assignment of incentives to RMMs/TBAs/CHWs • Random assignment of training to RMMs/TBAs/CHWs • Unit of randomization likely to be the community or village

8. Sample and Data • National • LQAS Monitoring data • 62 LGAs in 7 states • Baseline already conducted in late 2006 • Follow up in early/mid 2008 • Power calculations needed to determine detectable effect size • Pilot: • Primary household level data on representative sample of communities • Sample sizes to be determined

9. Staffing Plan • Impact Evaluation Team: • Impact evaluation experts (World Bank/IFS) • Country team (National/State/LGA Malaria Programs) • Local Academics • Data Collection (National Bureau of Statistics NBS)

10. Timeline • Short Run Activities: • Mid-May: technical work to randomize roll out of LGAs (training of PMVs) followed by a videoconference • June: Workshop in Abuja for planning of national impact evaluation • August: Country level workshop for M&E and IE for planning of pilot impact evaluations

11. Budget • Short run expenses: • Mid-May expenses for videoconference meeting (1 day, domestic travel for 15 people) • Expenses for training in June (6 days, domestic travel for 15 people) • August workshop (5 days, domestic travel for 15 people, venue, etc) • Budget TBD, aprox $100,000 for initial activities