Markets, voucher subsidies and free nets combine to achieve high bed net coverage in rural Tanzania

Abstract

<p>Abstract</p> <p>Background</p> <p>Tanzania has a well-developed network of commercial ITN retailers. In 2004, the government introduced a voucher subsidy for pregnant women and, in mid 2005, helped distribute free nets to under-fives in small number of districts, including Rufiji on the southern coast, during a child health campaign. Contributions of these multiple insecticide-treated net delivery strategies existing at the same time and place to coverage in a poor rural community were assessed.</p> <p>Methods</p> <p>Cross-sectional household survey in 6,331 members of randomly selected 1,752 households of 31 rural villages of Demographic Surveillance System in Rufiji district, Southern Tanzania was conducted in 2006. A questionnaire was administered to every consenting respondent about net use, treatment status and delivery mechanism.</p> <p>Findings</p> <p>Net use was 62.7% overall, 87.2% amongst infants (0 to1 year), 81.8% amongst young children (>1 to 5 years), 54.5% amongst older children (6 to 15 years) and 59.6% amongst adults (>15 years). 30.2% of all nets had been treated six months prior to interview. The biggest source of nets used by infants was purchase from the private sector with a voucher subsidy (41.8%). Half of nets used by young children (50.0%) and over a third of those used by older children (37.2%) were obtained free of charge through the vaccination campaign. The largest source of nets amongst the population overall was commercial purchase (45.1% use) and was the primary means for protecting adults (60.2% use). All delivery mechanisms, especially sale of nets at full market price, under-served the poorest but no difference in equity was observed between voucher-subsidized and freely distributed nets.</p> <p>Conclusion</p> <p>All three delivery strategies enabled a poor rural community to achieve net coverage high enough to yield both personal and community level protection for the entire population. Each of them reached their relevant target group and free nets only temporarily suppressed the net market, illustrating that in this setting that these are complementary rather than mutually exclusive approaches.</p

Contribution of Integrated Campaign Distribution of Long-Lasting Insecticidal Nets to Coverage of Target Groups and Total Populations in Malaria-Endemic Areas in Madagascar

“…Commercial nets, with a subsidized cost of US $1.5 or 3,000 ariary, 23 represent a smaller proportion of nets in these districts and were the secondary source of nets used by all age groups. This finding is unlike the findings of Khatib and others 14 from a district of Tanzania with multiple net delivery strategies, where campaign nets were used predominantly by young children, and commercial nets were the main source of nets used by older children and adults. Multiple factors may potentially explain the larger contribution of the integrated campaign to net use in targeted districts of Madagascar: a shorter history of ITN social marketing in Madagascar (six years) compared with Tanzania (more than 10 years), different campaign distribution strategies including social mobilization, or different socioeconomic or environmental drivers of LLIN uptake.…”

“…Lower ownership of campaign nets in the wealthiest households may reflect a reduced need for nets because of use of repellents and/or better constructed houses that reduce mosquito nuisance biting 11 or the tendency not to use free delivery mechanisms and rely more heavily on the open market. 14 The latter factor is supported by the economic disparity in ownership of nets from commercial sources. Cost was presumably a key limiting factor in the uptake of commercial sector nets by the poorest households.…”

“…[19][20][21] it has been suggested that these strategies are complementary and may serve to increase overall community-wide coverage. 14 Madagascar is located off of the eastern coast of Africa and has a population of approximately 19 million persons. Administratively, the country is divided into 22 regions and 111 districts.…”

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

“…21 The other two used a cross-sectional design to assess the fully subsidized delivery of ITNs during a stand-alone campaign 27 or during a campaign integrated with measles vaccination. 46 Nine studies presented the equity ratio, or sufficient data for its calculation, of ITN ownership among households or ITN use among children under 5 (Fig. 3).…”

Socio-economic status and malaria-related outcomes in Mvomero District, Tanzania

“…Turning first to prevention, we focus on ownership of insecticide-treated mosquito nets (ITNs). Tanzania has been a leader in implementing policies to promote and distribute ITNs throughout the country, initiating a programme of voucher subsidies for pregnant women in 2004 and subsequently extending these to children under five (Magesa et al 2005, Khatib et al 2008. Our interviewers asked survey respondents whether or not they owned any nets; 93% of survey respondents responded affirmatively.…”