Lessons learned from bednet distribution in Central Mozambique

Abstract

This project failed to achieve adequate or equitable levels of ITN coverage in a timely manner in the programme sites. However, its findings helped support a subsequent Mozambican decision to conduct targeted distribution of long-lasting nets to the neediest populations in the provinces where the project was conducted.

Household ownership and use of insecticide treated nets among target groups after implementation of a national voucher programme in the United Republic of Tanzania: plausibility study using three annual cross sectional household surveys

“…Although the multivariate analysis takes into account the effects of other distribution systems, we cannot rule out potential confounding by other factors that changed during the time the programme roll out occurred. Secondly, for some districts there is no true baseline measure of coverage: [36][37][38] the consistent gap between use of any net and use of a treated net suggests an urgent need to improve insecticide treatment of nets. The treatment gap has persisted despite considerable investment by the SMARTNET project in communications activities promoting net treatment and retreatment as well as efforts to work with manufacturers to ensure bundling of all nets with insecticide treatment kits.…”

Policy development in malaria vector management in Mozambique, South Africa and Zimbabwe

“…Although a younger generation of researchers favoured ITNs, they had little influence on decisions about which intervention to use: “Within the MoH, the older experts are very much in favour of spraying and the younger ones like spraying, but they would also like to see other methods of control used.” (Researcher, Mozambique) Researchers were, however, able to influence policy on net pricing by producing research evidence (Dgedge 2000; Brentlinger et al 2007). In South Africa, there was much greater reliance on the Malaria Advisory Group, a body set up by the National Department of Health:

“We felt that we needed to bring and call on expertise from the country to advise us on policy—and that’s the main reason why the decision was taken to put an advisory group together.” (Government official, South Africa)

The Malaria Advisory Group discussed ITNs and research was commissioned on their effectiveness, in comparison with IRS (Mnzava et al 1999).…”

“…The trial comparing IRS and ITNs (which showed similar results for both interventions) had been started (Goodman et al 2001), but was stopped early owing to a malaria epidemic that was seen to demand immediate intervention. In Mozambique, the involvement of researchers in the production of evidence around ITN pricing helped create a sense of local ownership (Dgedge 2000; Brentlinger et al 2007). …”

“…With the policy of commercial distribution, albeit at subsidized prices, householders had to not only accept nets, but also to pay for them. Even subsidized prices of between US$2.50 for a rectangular net and US$4.00 for a conical one had proved too expensive for the poorest households (Brentlinger et al 2007). …”

“…Local research later contributed to a policy change to free distribution to target groups (Brentlinger et al 2007). A movement for free nets had also been building internationally (Curtis et al 2003) and in 2007, WHO recommended that net distribution should be free or highly subsidized (WHO 2007).…”