Despite a significant reduction in the number of cases and deaths from malaria in sub-Saharan Africa over the last decade, the burden of the disease remains unacceptably high.
Among the most important tools used to prevent transmission of the disease are insecticide-treated nets (ITNs), which provide both a physical and chemical barrier against malaria-carrying mosquitoes. Whilst the benefits of ITNs are universally acknowledged, the question of how to best distribute these nets remains hotly debated.
A major debate has emerged regarding the use of mass distribution campaigns versus distribution through commercial markets. The reach of the latter has been increasingly questioned, with critics suggesting that access to ITNs via the private sector is too limited for those on low-incomes or for more remote rural communities, and cannot compete with a demand for free nets. As a result, free distribution has become a top choice for many governments and donors.
However, as mass public distribution campaigns in the region are recognised as being only part of the solution, alternative and sustainable solutions are needed to maintain high net coverage. As part of this process, since 2003, Malaria Consortium has sought to identify strategies that could strengthen the capacity of the private sector to support universal net coverage in sub-Saharan Africa.
A number Malaria Consortium's projects have focused on achieving high coverage of long-lasting insecticidal nets (LLINs) – the most effective type of mosquito net currently available – and supporting a shift away from other less effective, untreated nets. This involved encouraging the local production of nets, providing assistance to local private sector distributors of LLINs and facilitating a reduction in the price gap between untreated nets and LLINs through direct consumer price subsidies.
In Uganda, Mozambique and Nigeria, Malaria Consortium found that working with the private sector had real potential to improve net coverage. The lessons learned from these activities, outlined in brief below, have been detailed in a recent learning paper on the subject, Insecticide treated nets: the role of the commercial sector.
Lessons learned
In Uganda, Malaria Consortium's efforts to bolster market capacity for the distribution of ITNs were aided by an established net culture in the country. As a result of existing net use, the increase in free mass distribution campaigns did not damage sales within the retail market – in fact, institutional sales supported demand for mosquito nets. Furthermore, social marketing efforts (which aim to prime markets through brand promotion) can reinforce sales as long as they are appropriately time-limited.
In contrast to Uganda, Mozambique had a limited net culture prior to the implementation of the programme. Despite the lack of a LLIN market, Malaria Consortium's support mechanisms were sufficient to attract distributors and ultimately facilitate the sales of 750,000 ITNs, even in the face of potential competition from large free public distributions. Whilst there was not an increase in market sales at the end of the project, LLINs had taken over as the net of choice, replacing less-effective ITNs and untreated nets. Institutional sales and the price subsidy for LLINs were critical to achieving this.
Support for the commercial ITN sector in Nigeria started in much the same way as it did in Uganda and Mozambique. However, concerns were raised that the approach used was not adequate given the free mass distributions, leading to the termination of direct support to the distributors. While the programme lasted, it established LLINs as the leading market product and demonstrated that free public distribution created additional demand for LLINs for households that were missed during mass campaigns or who wanted to buy additional nets.
Learning Paper
For a more in-depth look at the role of the private sector within the context of LLIN distribution, read Malaria Consortium's learning paper, Insecticide treated nets: the role of the commercial sector.
To learn more about the role of the commercial sector in the distribution of antimalarial supplies and the provision of nets in Nigeria watch this film.
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