NIGERIA

NetMark was active in Nigeria from April 2002 to September 2009. While NetMark was a nationwide project in Nigeria, the Project undertook major interventions in Lagos, Kano, Cross River, Nassarawa, the Federal Capital Territory (Abuja), Kwara, Benue, Bauchi, Abia, Plateau, Ogun, Edo, and Oyo States.

USAID Country Budget: $9,838,124
Commercial Partners’ Investment: $36,283,856

NETMARK PARTNERS

Syngenta Nig. Ltd	IconLife® and icoNet®
Harvestfield Nig. Ltd	CyperNetPlus® and DuraNet®
Rosies Garments Ltd	Rosies Net® and NetProtect®
Afcott Nig. Ltd	KO-Net® and DawaNet®
Sunflag Nig. Ltd	PowerNet®
Vestergaard Frandsen	PermaNet®
Chi Nig. Ltd	K.O. Net®

ENABLING ENVIRONMENT

NetMark worked with the Federal Ministry of Health’s National Malaria Control Program and other Roll Back Malaria partners to development a strong public private partnership for ITN promotion in Nigeria.

NetMark was very active in advocacy activities that involved the Federal Ministry of Health, the Ministry of Finance, and the Nigeria Customs Service to ensure that taxes and tariffs issues, as related to ITN and treatment-kit imports, were given priority – in order not to discourage partner investment.

The taxes and tariffs (T&T) on ITNs and related products have stabilized, after having gone through several fluctuations in the past (25% to 5% to 75%).

The current T&T situation is:

Insecticides 0%
Mosquito Nets 20%
Insecticide-treated Nets 10%
Long-lasting Insecticidal Nets 0%

NetMark and its partners played a major role nationally in Nigeria between 2001 and 2009, implementing a wide spectrum of promotional activities. The project was most active in Lagos and Kano States; ITN activities by the different partners varied by state. National and international groups have promoted the use of ITNs in a variety of ways, including behavior change communication using radio spots, television ads, community meetings, and public dramas; distributing free nets; using social marketing to provide nets at reduced prices; implementing voucher programs to provide free or cost-reduced nets; and expanding the capability of various elements of commercial markets.

From 2000 to 2004, NetMark activities focused on demand creation, strengthening the private sector, and making subsidized nets available to vulnerable groups. Since 2004 large-scale programs to make nets available free to families have been implemented. The table below summarizes activities undertaken by NetMark, its partners, and others in the states where baseline and endline surveys took place.

ITN Promotion Activities in the Study Sites

SUPPLY OF ITNs

Brands and Sales:
At the beginning of the project only three local distributors (CHI Pharmaceuticals Ltd, Sunflag of Nigeria, and Dangote Nig. Ltd) existed with five brands of ITNs (K.O.Net®, SolfacNet®, PermaNet®, IconLife®, and PowerNet®) in Nigeria. From 2002 to 2009, NetMark’s formal partners have grown from four to seven in number, with 25 informal partners – including local net stitcher associations – in the major textile markets in Nigeria.

There are currently over 25 brands of ITNs (including polyester and polyethylene LLINs) in Nigeria, which is a remarkable improvement from the situation according to the 2000 Baseline Survey when there were no ITNs available in the market.

Sunflag Nig. Ltd is a textile manufacturing company that is fully integrated to produce netting materials. With NetMark support, Sunflag has acquired the USAID/NetMark-developed (WHOPES-approved) technology for LLIN production and will begin commercial production in September 2009.

Between 2002 and 2009, a total of 19 Million ITNs have been sold through the private sector in Nigeria. Insecticide-treatment kits sold by NetMark commercial partners between 2002 and 2009 have reached 5.8 million units.

Retail Outlet/Accessibility:
The number of retail outlets in the country selling ITNs grew from fewer than 20 at the beginning of the project to over 4,500 in 2009, the final year of NetMark.

Price:
As a result of increased competition, the increased quality of ITNs/LLINs, and the stability in taxes and tariffs, the price range of an ITN/LLIN on the retail market decreased from $6.00 - $15.00 in 2002 to $3.50 - $11.00 in 2009.

Local Production of ITNs:
NetMark identified and supported net stitchers in three major textile markets in Nigeria: Aba, Kano, and Lagos States. NetMark worked with these stitchers to link them and obtain local sources of netting material that met WHO standards for the production of bundled ITNs. NetMark also trained the stitcher associations in best business practices and in how to access funding, and linked them with insecticide suppliers.

In addition, NetMark also provided the associations with Thermo sealing machines, treatment kits, and labels to improve the quality of their packaging for their bundled ITNs. Over 20 brands of ITNs are now being produced by these stitchers.

NetMark began working with local net stitchers in Nigeria in 2005 when none of them sold a single ITN. To date, these stitcher associations have produced an estimated total of 6 million ITNs, which are largely sold in open markets where lower income groups shop.

EQUITY – VOUCHER PROGRAM AND FREE NETS

Vouchers:
NetMark used voucher programs to demonstrate how the commercial market can create demand and promote equitable distribution of ITNs. Using ExxonMobil funding, NetMark conducted two targeted subsidy discount-voucher programs in Lagos State enabling 163,000 pregnant women and children under five to access ITNs at subsidized prices through retail outlets. As a result of low attendance figures at immunization clinics, NetMark then partnered with the COMPASS project (a sister USAID Implementing Partner) to conduct a targeted subsidy program in seven Local Government Areas (LGAs) in Nassarawa State. The objective of this voucher program was to increase uptake of vaccines and DPT3 immunization by children by providing discount vouchers for ITNs to the families of immunized children. During this intervention over 17,000 vouchers were redeemed, indicating at least 17,000 children completed their DPT3 immunization.

NetMark’s average voucher-redemption rate in Nigeria has been 86%.

Community Distribution of Free Nets:
NetMark, in partnership with three NGO partners – Malaria Parasite: Africa Fights Back, the Delybimb Malaria Foundation, and the WomanKind Organization – conducted free ITN distribution activities in rural communities in Kano, Benue, Abia, Bauchi, Lagos, Cross River, the Federal Capital Territory (Abuja), and Nassarawa States, totalling 305,000 ITNs.

Free Net Distribution Linked to Immunization Campaigns:
NetMark successfully distributed 673,000 LLINs, donated by USAID and the Canadian government, in 18 LGAs in Cross River State during the integrated measles campaign there.

NetMark again partnered with three NGO partners – Malaria Parasite: Africa Fights Back, the Delybimb Malaria Foundation, and the Royal Covenant Heritage Foundation – to ensure a successful distribution. During the integrated measles campaign, LLINs were given to all families of children under five years who had been vaccinated.

HOUSEHOLD OWNERSHIP AND USE

Ownership of Nets and ITNs:
In 2000, only 6% of women surveyed had heard of insecticide-treated nets (ITNs) but by 2008, awareness of treated nets was nearly 100%.

The percent of households owning at least one net almost tripled from 2000 to 2008: from 10% of households in 2000 to 29% in 2008. In 2000, no households owned an ITN but by 2008, one in five households did. Now 70% of nets owned are ITNs (including long-lasting insecticidal nets, or LLINs).

In Nigeria, net and ITN ownership is strongly associated with socio-economic status (SES), and nets and ITNs are more common in Lagos State and in urban locations than in other locations. Efforts should be intensified to ensure that nets reach the rural and poor populations.

Use by Vulnerable Groups:
The household members most likely to be using the net are those most vulnerable to malaria: children under five – especially children under one – and pregnant women.

The great majority of respondents surveyed in 2008 knew mosquitoes cause malaria and could name the signs of simple malaria. Perceptions of ITNs as a solution for malaria and mosquitoes are much more positive, and fears about the insecticide for children under five and for pregnant women have greatly diminished. Nigeria started with no ITNs in 2000, and since then the number of children and pregnant women sleeping under an ITN has been growing, albeit slowly. The pace of protection was slowed by increasing proportions of nets going unused, detailed in the section below.



As with ITN ownership, use of ITNs by both children under five and pregnant women increased with socio-economic status. Children and pregnant women in the lowest SES quintile were most likely to sleep under an untreated net, and children in the top three quintiles were much more likely than others to sleep under an ITN. There was, however, little difference between urban and rural areas.

Overall Household Use:
Although there are a great many more nets in Nigeria now than there were in 2000, the percent of nets owned that had been used the prior night declined – from 92% in 2000 to 57% in 2004 and 2008.

Nets that were paid for were somewhat more likely to be used (65%) than those acquired free of charge (61%). The most common reason given for not using a net was that there were not many mosquitoes around; it will be critical to use behavior-change communication so that people know it is important to use the net even when there are few mosquitoes. The second most common reason given for not using the net was that is too hot or there is not enough air under the net. Possible product modifications could address this barrier.

Net use may also improve if parents are able to get a net in the size, shape, and color they prefer. Few associated ITNs with killing insects other than mosquitoes, and it is likely that use would be increased if families knew that an ITN does indeed kill other insects.

CONCLUSIONS

Since the 2000 survey, the overall “net picture” has changed for the better in Nigeria. Awareness of ITNs was initially very low but is now nearly universal. Household ownership of nets, and especially ITNs, has been increasing, though slowly and unevenly from state to state, with greater increases among higher socio-economic households. The percent of nets owned that are ITNs has risen dramatically with increases in ownership of LLINs and bundled nets (nets sold with a treatment packet).

The most vulnerable household members are given priority for using the household net. Within net-owning households, children under five and pregnant women are most likely to be using a net.

However, in 2008 only 57% of nets owned had been used the prior night, so increases in net ownership have not translated into proportional increases in protected individuals.

Thus there are two key challenges in Nigeria. The first is to increase ITN ownership steeply and to do so in an equitable manner – with commercial, subsidized, and free nets all playing a role. The second is to increase utilization of nets owned based on a sound understanding of the factors that would enhance and inhibit net use.