Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience

TLDR

Malaria remains the leading cause of health service attendance, hospital admissions, and child deaths in Tanzania, prompting the 2000 Abuja Summit commitment to protect 60 % of high‑risk populations by 2005 and driving the country’s determination to implement sustainable national‑scale insecticide‑treated net control. The study aims to create an enabling environment that makes insecticide‑treated nets accessible and affordable for all malaria‑at‑risk individuals, including establishing a commercial sector and a voucher scheme for pregnant women. Tanzania’s approach involved two decades of research on insecticide‑treated nets—testing insecticides, net types, efficacy, and distribution—followed by a shift to a concerted multi‑stakeholder action (NATNETS) to scale up nets nationally, including commercial sector development and voucher schemes. Nearly 2 million insecticide‑treated nets and 2.2 million re‑treatment kits were distributed in 2004, demonstrating that national upscaling is possible when the programme is well designed, coordinated, and supported by committed stakeholders, making the Abuja target of protecting 60 % of high‑risk populations feasible even in large endemic countries.

Abstract

Abstract Introduction Malaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale. Case description Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004. Conclusion National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries.