This working paper was originally prepared for a High Level meeting on scaling-up insecticide treated net coverage convened by the United Nations Foundation (UNF) in Paris on 7 September 2005 as a follow-up to an initial meeting convened by UNF and the Canadian International Development Agency (CIDA) in Geneva, on 23 June, 2005. The purpose of the meeting was to discuss the feasibility of a rapid scale-up (\"quick win\") to protect all pregnant women and children under five years by 2010 with insecticide treated nets (ITNs) with an emphasis on long lasting insecticidal nets (LLINs). This document aims to provide a basis for planning for such a scale-up by evaluating the future commodity and operational costs associated with providing universal coverage with ITNs for pregnant women and children under five years in malaria endemic areas of Africa. Following the recommendations of the meeting on 7 September 2005, the working paper has been revised based on comments from participants in that meeting, members of the Roll Back Malaria Partnership Working Group on Insecticide-treated Nets (WIN), WHO and UNICEF staff working on malaria control and vector control as well as other partners.
The advantages and disadvantages of alternative delivery channels are explored. Technical and epidemiological rationale are used to conclude that the best way to achieve universal coverage is to build universal provision through routine services, antenatal clinics (ANC) and the Expanded Programme on Immunization (EPI), as the primary method of delivery. Whilst these routine health system-based delivery channels will cover the majority, it is recognized that they should be complemented by other channels, EPI outreach, community based systems and/or Child Health Days/Weeks (CHD/W), with which to reach those who do not access these routine ANC and EPI services. The combination of these systems provides a ‘keep-up’ of sustained delivery of ITNs.
Combined delivery of ITNs with immunization campaigns has recently provided an exciting opportunity for rapid scale-up of equitable ITN coverage as shown in a number of countries. Whilst recognizing the advantages of this channel as a quick-fix ‘catch-up’ delivery system, the disadvantages of the ‘transient’ coverage achieved are outlined as the reason that such campaigns are most useful as a complement to routine systems. In countries where routine systems are very weak, such as those in complex emergencies, campaigns may be the best way to deliver ITNs in the longer term, until health systems become stronger.
(Re) treatment campaigns are proposed as a way of rapidly scaling-up coverage of ITNs in countries where there is relatively good coverage with mosquito nets.
Donors considering investing in one or other of these systems should consider giving long-term support for routine services, which are better able to address the challenge of providing continuous coverage to pregnant women and children under five years with ITNs. This kind of support may help substantially in the long-time priority of strengthening health systems.
The numbers of ITNs needed to cover the target population of pregnant women (25.6 million) and children under five years (109.7 million) at risk of malaria in Africa are calculated, using a mix of delivery channels. Cost data from previous studies on ITN programmes are used to estimate the funds needed to deliver this number of ITNs over a five year period. These estimates are simplistic and much more detailed costing is required to gain more accurate figures. However, using the methods and assumptions outlined in the report and taking into account the simplistic nature of our methods, we estimate that 312.3 million ITNs are required to deliver to the target group over a five year period through ANC, EPI and planned measles campaigns, at a cost of US$ 2.27 billion.
Paper prepared for the Global Malaria Programme, World Health Organization. 53 pp.