New evidence of progress against malaria

BLANTYRE

Combining the strengths of commercial markets and public health centers has allowed efficient, cost-effective delivery of life-saving mosquito nets in Malawi, says a new study in the Malaria Journal, ensuring the country is one of the first to reach the 2005 targets set by world leaders in the Abuja Declaration.

The Government of Malawi has scaled up distribution of life-saving mosquito nets to its people from 13 per cent to 60 per cent of households in just four years, and has seen program costs decrease significantly while doing so, according to a new study of economists and public health experts published in the Malaria Journal this month (see the study at www.malariajournal.com).

In 2000, the Ministry of Health (MOH) and PSI teamed up with international agencies including UNICEF, WHO and the U.S. Agency for International Development to sell insecticide-treated mosquito nets (ITNs) via all available commercial vendors and public health centers.

"With one of the main Abuja Declaration goals being to achieve at least 60 per cent coverage of pregnant women and children under five years of age with ITNs, more programs need to see the results that combining public and private efforts can have in achieving rapid results in a sustainable manner," the authors say in the report.

The strategy involves segmenting the total market to sell a more expensive blue conical net to consumers for $5-6 through private sector outlets targeting those who can afford it.

In public health facilities, a highly subsidized green rectangular net is sold to pregnant women and children under five - those most vulnerable to malaria - for $0.50.

All nets are branded and heavily promoted to the public through a range of mass media and interpersonal communications channels.

ITNs are a proven effective intervention to reduce the incidence of malaria morbidity and mortality and one of the most cost-effective ways of reducing the burden of malaria.

The difficulty is in finding the most effective way to deliver nets -to rapidly achieve household coverage with minimum delivery costs, ensuring that the poorest households are covered and that a sustainable delivery system is put in place.

The key finding of this study is that, in the Malawi model, costs are decreasing as the program grows - an increasing return to scale the authors call "scale efficiency savings".