Research

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

Rashid A Khatib¹ , Gerry F Killeen^1,3 , Salim MK Abdulla¹ , Elizeus Kahigwa¹ , Peter D McElroy⁴ , Rene PM Gerrets⁵ , Hassan Mshinda¹ , Alex Mwita⁶ and S Patrick Kachur²

¹  Ifakara Health Research and Development Centre, P O Box 78373, Dar es salaam, Tanzania

²  Centers for Disease Control and Prevention, Division of Parasitic Diseases National Center for Zoonotic, Vector-Borne & Enteric Diseases Coordinating Center for Infectious Diseases, Strategic and Applied Sciences Unit, Malaria Branch, 4770 Buford Highway, NE Mailstop, F-22 Atlanta, Georgia 30341, USA

³  Durham University, Institute of Ecosystems Science, School of Biological and Biomedical Sciences, South Road, Durham, DH1 3LE, UK

⁴  Centers for Disease Control and Prevention, President's Malaria Initiative, American Embassy, P O Box 9123, Dar es salaam, Tanzania

⁵  Max Planck Institute for Social Anthropology, PO Box 11 03 51, 06017 Halle/Saale, Germany

⁶  Ministry of Health and Social Welfare, National Malaria Control Programme, P O Box 38112, Dar es salaam, Tanzania

author email corresponding author email

Malaria Journal 2008, 7:98doi:10.1186/1475-2875-7-98

Published:	2 June 2008

Abstract

Background

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.

Methods

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.

Findings

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.

Conclusion

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.