Table 1: Key Thematic Issues Related to the ITM Program Process

	Assessment	Planning	Implementation	Monitoring & Evaluation
Demand	Solicit help of experts with assessment: marketing firms for formative research Find out current demand for and existing use of mosquito and malaria control characteristics of consumer/client/user demand at political and policy level, political commitment current perception of the importance of malaria present control measures needing improvement Look at supply issues as they relate to demand	Coordinate contribution of stakeholders (roles and responsibilities, mechanism for communication) Mix messages and channels of communication (use formative research to define mix) Use well-established processes for development and execution of demand creation (lessons learned from other sectors) Create overall strategy and plan.	Use what has been learned about the customer/client/user Be ready to make adjustments: things change with time; a single approach won't last forever View creation of an ITM culture as a long-term process Convince policymakers that users come first Don't create demand if supplies are not available (coordinate supply and demand) Include policymakers in kick-off (include all players in start-up).	Monitor demand creation (sales, repeat usage, outlets, distribution surveys) Make programmatic changes based on monitoring information Set key indicators: sales, utilization, consumer satisfaction Carry out KAP studies of users to compare with baseline KAP Decide what mechanisms will be used for information gathering in the planning
Accessibility	Look at existing delivery channels both public and private for opportunities to piggy back Take an inventory of the policy constraints or opportunities related to the import, manufacture, distribution, and promotion of ITMs, i.e., government policies re taxes, duties, registration Look at the capacity of institutions at all levels to ensure availability of nets and insecticides Look at availability at the country, regional, and community level (supply, manufacturer/ importer; current inventory) Access consumer behavior in the marketplace re ITMs and similar consumer goods Find out where nets come from, how they are being sold and distributed, and what distribution channels reach the target group.	Take into account all aspects of planning (as given in guidelines) Involve all appropriate stakeholders initially in coordination with the national malaria control program Look at a large-scale programC even beyond national borders; provide guidelines for replication Look at the programmatic framework and connections with other related programs and sectors Develop an implementation plan.	Provide a continuous source of technical support Ensure adequate supply and re-supply of nets and insecticides Prioritize projects based on epidemiology of malaria within a region or country Use existing groups to distribute ITMs	Incorporate feedback mechanism on rates of malaria morbidity Cover costs for the initial purchase of nets and retreatment Evaluate financing and subsidy schemes Assess how subsidies for targeted groups might affect the unsubsidized markets
Affordability	Find out volume and price of ITMs currently being sold who is or is not buying them (if nets are available) and why (income, geography, risk groups) current financing schemes economic profile of target population current subsidy patterns by target groups Identify other household expenditure patterns and priorities Gain an understanding of the policies and practices of the health system re distribution and availability of products	Find out whether ITMs are a national strategy or a local program what financing schemes (at household and community level) will be used Examine implications of dealing with nets as health products or commercial products Forecast the growth of the ITM market and estimate its implications for price and logistics Decide who should set prices and how they should be set: equity issue If market sets price, consider subsidies Set up a system of out-sourcing Look at cost structure and how it will change over time Articulate long-term vision for net/insecticide use Decide who will pay for what and how long.	Investigate credit schemes for poor populations Examine lessons learned in cost-recovery from other ITM projects: Eritrea, Kenya, Tanzania Promote public-sector role in assisting the poor and creating incentives for the private sector.	Involve the consumer in monitoring and evaluation plans Expand standard management information systems Define indicators for effectiveness of ITMs at all levels.
Appropriate Use	Find out how nets are being used Achieve an understanding of the parameters of transmission in the target area: behavior of people, behavior of vector, environmental conditions Examine operational conditions: policies and regulation, health and administrative infrastructure, commitment, resources available/ mobilizable.	Decide on measurable, realistic goals Identify target groups: Who needs to use ITMs? Establish clear roles and responsibilities/partnerships Develop training for various groups.	Ensure that retreatment services are provided Design IEC programs to supplement technical support.	Link methods for monitoring use of ITMs at the local level with those at the national level of health information systems Examine how many bednets are used, what percent retreated, and ultimately whether or not use of bednets and ITMs affect mortality and morbidity.

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