Scaling-up Delivery of Insecticide-treated Nets
Situation:
As a cost effective, sustainable control method for protection against malaria transmission, long lasting insecticide-treated nets (LLINs) are being promoted by WHO and RBM. The insecticide treatment on LLINs lasts longer than that on conventional Insecticide Treated Nets (ITNs) which require retreating every 6 to 12 months. There are at present three marketed nets - Olyset Net®, which has 2% permethrin incorporated into the polyethylene fibres, PermaNet® which is treated with 55mg/m2of deltamethrin to coat fibres, and Interceptor®, a LLIN manufactured by BASF.
Response:
The Malaria Consortium is involved in several projects concerning LLINs, and is concerned with cost effectiveness as well as the sustainability of the net delivery through the public and private sectors:
The MC is currently conducting a large scale study to look at costs of delivering LLINs through ante natal clinics in northern Uganda IDP camps. Through this method, 210,000 nets were delivered over three years, covering 83% of pregnant women. This in turn lead to an increase in women attending ANCs and increased their knowledge and understanding of the importance of using nets for all the family. The cost of delivery through this method was $1.50 per net, including all personnel, training and net costs. A similar survey is planned for our operations in Mozambique.
The Malaria Consortium is also involved in developing a sustainable market for ITN delivery in Mozambique, as well as advising on scaling up malaria control programmes in Sudan, Ethiopia, Zambia, Tanzania and Uganda. An approach to scale-up of ITNs is through support to the commercial sector to raise access to ITNs overall. The commercial components of our Mozambique and Uganda programmes aim to support the private sector, allowing them to market their own brands. Support goes directly to net distributors, via the retail market, with a focus on rural markets and LLIN promotion.
In Uganda, the AFFORD Health Marketing Initiative (USAID funded, led by a consortium of partners including the Malaria Consortium and Johns Hopkins University) distributes millions of long-lasting insecticidal nets (LLINs) with PMI support. The objective is to support Uganda to achieve the national and President's Malaria Initiative (PMI) target of 85% of pregnant women and children under-five sleeping under an ITN by 2010. The strategy is to distribute nets through ANCs to pregnant women, to use a community based distribution network through civil society organizations (NGOs/FBOs) and to increase availability through the commercial sector thereby strengthening local commerce.
Currently all pregnant women at their first ANC consultation in three provinces receive an LLIN and advice on its importance and how to use it. This DFID-funded programme is also developing linkages between national distributors and international manufacturers of quality LLIN and ITN. These linkages are supported by limited incentives to encourage entry and limit the risk for companies on the nascent commercial market for nets. In this way, the quantity and range of nets available to the public, a public encouraged to become increasingly discerning through supportive marketing and mobilization messages, is increasing. Distributors are encouraged and supported in the design of innovative ideas to extending outreach into more rural markets.
Points to note:
Organised free provision of LLINs, has an important role to ensure malaria protection to those most vulnerable to malaria such as pregnant women, children under five and the very poor rural people. However, improving access to LLINs through the commercial sector is vital to ensure access to replacement nets after they have reached the end of their useful life.
There is now global consensus around the WHO Strategic Framework for Scaling-Up ITNs in Africa, which recognizes a multisectoral role for both the public sector (targeting vulnerable groups for free distribution to promote equity) and the private sector (for commercial distribution systems). Our projects also take this approach, integrating ITN delivery with maternal and child health programmes, whilst concurrently working with the private sector in a complementary and supportive manner to ensure that coverage can be maintained.
See "AFFORD" [Link],"Developing a sustainable ITN Market in Mozambique" [Link], "Scaling up in Sudan" [Link] and "Clover" [Link] for more details on separate programmes.
Photos: Malaria Consortium