While I was helping out with the mosquito net distribution, I thought to myself I never want to see a mosquito net again in my life, but then I remembered that 1) I sleep under one every night  2) I actually hope that I see them everywhere, in people’s houses after the distribution and 3) all of the hospital beds have one as well.

So, thanks to the Global Fund to Fight AIDS, Tuberculosis and Malaria, Cameroon received 8.7 million mosquito nets to distribute across the country. My health district got 55,000 of them. I helped supervise as they arrived to my hospital, then supervised again  as they got loaded onto trucks again, over a three day period, to be sent to various distribution points, counting very, very carefully to ensure that each place got its right share of nets.

Each bundle contained 50 nets, so if a distribution center was allotted a number that wasn’t a multiple of 50, we had to open a bundle up and count out the number of individual nets.

Finally, I got to help hand them out on distribution days – two days at my hospital and three days of the villages, Gance, which is a half-hour bike ride away. (And then, last week, a third day at our hospital, when some places had nets that were unclaimed.) Our hospital distribution was actually mostly organized – look, people are lined up!

The whole process was just really stressful and nerve-wracking for everyone involved. “Mosquito net distribution” is a phrase that gets tossed around so often, so it was really interesting to see how the whole process played out. “

Well, pretty much anything that could have gone wrong went wrong. People from the community were trained to go door-to-door to take a census of the people in each household and hand out a voucher stating how many mosquito nets they would receive. Then, people would then gather at various distribution points to receive their nets. Well, for one, a lot of people never got censured.

Here’s just a few more things that went wrong:

Timing: For one, it was scheduled to originally start in August, during rainy reason, which is a terrible plan because the roads can be impassable and because malaria cases are already starting up. Then, when it finally happened during the past few weeks, during dry season, people were already saying that they would not use them, because they insist “there are no mosquitoes.” Okay, yes, it’s true that there are a lot fewer mosquitoes around, but considering how there are malaria cases year-round, they definitely still exist.

Also, in the Far North, health centers were told to hold off on mosquito net distribution, possibly because of the presidential elections held October 9. One of the hospital workers told me that it was because in the South, when they had already distributed nets, people were saying that the nets came from President Paul Biya himself, in an effort to get him more voters for re-election… but who knows for sure.

Proper Use/Non-Use: Of course, it’s hard to know if people will actually use them for their intended purpose, or if they’ll just sell them or use them for fishing nets. It’s one of the many problems with the distribution of something so valuable, that people will want it only because it’s free. One person at each distribution site is also supposed to be in charge of regularly explaining to the crowd how to use the nets, but I doubt that every person receiving a net got the necessary information. We got really frustrated at one woman who came in to get her mosquito nets with her 13 month old baby, yet she had never bothered enough to bring her baby in for free vaccinations. (So, she can’t use “transportation” as an excuse for non-vaccination.) Myra, the Canadian administrator, even threatened to take her mosquito nets from her until she came back to get the baby vaccinated. (A case of polio was just discovered a few weeks ago in Limani, one of the health centers in our district. The patient was from Nigeria.)

Fraud/Corruption: Cameroon is well-known for its corruption, which is definitely a factor in its slow development. And the mosquito net distribution was no exception, despite the efforts for transparency. There was a lot of fraud, at multiple levels. The number of mosquito nets to be distributed was based on the household size – a family of 3 gets 1, a family of 5 gets 2, etc. – and many people lied and increased their size in order to get more nets.

Insufficient nets/Mayhem: We started off distribution knowing that we were sent an insufficient number of nets. I think that our district’s population census showed 30,000 more people than expected – which may also be related to the people increasing the number of family members to get more nets. So, distribution was supposed to last for 3 days at our hospital, but we ran out at a bit past noon on the second day, much to the anger of the people who were still in line and the rest of the community. Apparently, at other distribution centers, people actually broke out in fights. When I was at Gance, the gendarmes had to come in and help keep order.

Incompetency of community workers: Community agents were supposed to carefully fill out vouchers with all of the necessary information. It was already hard enough to find people who were literate, but there was still a lot of lack of comphrension. The most important part was the “household number,” with three  blanks next to it (_ _  _) where each household got a unique 3 digit number, in order to make it easier to verify that the family was in the original census, in the large registry of names. Some gave household codes of “002” – apparently the number of mosquito nets – rather than something like “324.” Or some put the squished the whole three-digit number into the last blank, making it nearly impossible to decipher. Some people didn’t even have a household number. It just slowed down the process a lot., while others simplydidn’t get nets because their entry could not be found in the register.

I also found this, which is a good summary as well: http://www.malariaworld.org/blog/mosquito-net-distribution-drive-blotched