The equitable distribution of insecticide treated nets (ITNs) to prevent malaria transmission in Africa has always proven a challenge for governments and public health organisations alike. Not only are populations often spread out over vast stretches of land, but there are also a host of logistical obstacles in transportation and delivery. To make matters worse, delivered nets are often neglected due to the lack of a ‘net culture’ in many countries – meaning that some might prefer to use the nets for catching fish rather than for protection against mosquito bites.
The fact is that in some regions, net coverage remains far too low. Finding the most effective distribution methods has become a priority for public health organisations and ministries of health, and is a matter of intense debate among experts. The discussions over distribution have raised several questions regarding the effectiveness of the private and public sectors in getting ITNs to those who need them. Does distribution through the commercial sector exclude the poorest groups? And are mass public distribution campaigns of free nets sustainable given that external funding patterns are sometimes unpredictable?
With mass campaigns increasingly being recognised as only part of the solution, alternative and sustainable methods of distribution are being sought to maintain high net coverage. As part of this process, Malaria Consortium has implemented projects that aim to strengthen the capacity of the private sector to support universal net coverage in sub-Saharan Africa. In a learning paper entitled Insecticide treated nets: the role of the commercial sector, written by Dr Albert Kilian, the organisation shares lessons learned from increasing private sector engagement in the distribution of ITNs in Uganda, Nigeria and Mozambique.
Malaria Consortium found that working with the private sector has real potential to improve net coverage. In Uganda, for example, results showed that, aided by an established net culture, an increase in free mass distribution campaigns did not damage sales within the retail market – in fact, institutional sales supported demand for mosquito nets.
By contrast, results in Mozambique indicated that, even with a limited net culture and despite competition from large free public distributions, support mechanisms were sufficient to attract distributors and facilitate the sales of 750,000 ITNs. Results also showed that long lasting insecticidal nets (LLINs) had taken over as the net of choice, replacing less-effective ITNs and untreated nets.
You can read more about the role of the commercial sector in helping to attain and sustain universal LLIN coverage by viewing the learning paper here.
To learn more about the role of the commercial sector in the provision of LLINs and the distribution of antimalarial drugs in Nigeria, you can watch this film.