Research

The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi

Warren Stevens¹ , Virginia Wiseman² , Juan Ortiz³ and Desmond Chavasse⁴

¹  MRC Laboratories, PO Box 273, Banjul, The Gambia

²  Health Policy Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

³  UNICEF, P.O. Box 30375. Lilongwe 3, Malawi

⁴  PSI Malaria Department, Po Box 22591-0400, Nairobi, Kenya

author email corresponding author email

Malaria Journal 2005, 4:22doi:10.1186/1475-2875-4-22

Published:	10 May 2005

Abstract

Background

Insecticide-treated nets (ITNs) are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold.

Methods

The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY) and cost per net distributed.

Results

The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN) to $3.44 in year five (720,577 ITN). Cost/ITN distributed dropped from $5.04 to $1.92.

Conclusion

Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved.