Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets

Abstract

Background: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.

Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review

“…45,49,50 In the fourth study, the delivery of partially subsidized ITNs to pregnant women via antenatal care clinics in the United Republic of Tanzania was examined. [32][33][34][35] The fifth study reviewed a stand-alone ITN campaign involving distribution of fully subsidized nets to children under 5 in the Micheweni district of Zanzibar. 41 Table 2 shows the variety of study designs used to assess ITN delivery strategies.…”

“…22,27 The study at the national scale reported an economic cost of US$ 10.77 per ITN delivered. 25,35 Of the four studies that evaluated the delivery cost of partially subsidized ITNs, three investigated delivery through the retail sector and one investigated voucher use. Studies of retail-based delivery reported financial costs of US$ 5.47 and US$ 11.16 per ITN delivered in Burkina Faso and Malawi, respectively, and of US$ 12.57 and US$ 18.72 per treated-net-year in the United Republic of Tanzania and Malawi, respectively.…”

“…The fourth study investigated the Tanzanian National Voucher Scheme and found economic costs of US$ 10.77 per ITN delivered and US$ 6.02 per treated-net-year, with the latter calculation assuming 12-month protection from a treated net. 35 The four studies that evaluated fully subsidized campaigns found financial costs per ITN delivered of US$ 3.71 to US$ 11.79 for those integrated with vaccination campaigns 30,45,49 and US$ 9.48 for a stand-alone campaign. 27 The standalone campaign considered in one of the studies had an economic cost per ITN delivered of US$ 4.76.…”

“…27 Three studies presented some measure of health impact. The economic cost per child death averted was US$ 1242 for a national voucher scheme 35 and US$ 2924 for a retail sector programme involving partially subsidized delivery. 36 The economic cost per disabilityadjusted life year averted was similar, at US$ 100 and US$ 107.…”

Adaptation to Climate Change in Developing Countries

“…However, this is not perceived as appropriate to the whole population. Lastly, insecticide treated bed nets (ITNs) is an option, which have shown to be an effective, feasible and economic attractive measure in reducing mortality and morbidity from malaria (Goodman and others 2001, Hanson and others 2003, Lengeler 2004, Mueller 2008and Mulligan 2008.…”