Senegal

SENEGAL

NetMark was active in Senegal starting in 2002. While the Project works nationwide with its partners in Senegal, the NetMark targeted subsidies program has focused on seven regions: Thiès, Louga, Kaolack, Ziguinchor, Kolda, Dakar, and Fatick.

NETMARK PARTNERS

Palunet, Dawa Plus® and
Sentinelle™ (began 2002)
DNS, Permanet® (began 2005)
SONY, OlysetNet® (began 2005)
MAGU, IconLife® (began 2006)

USAID Country Project Budget: $8,625,769
Commercial Partners’ Investment: $13,354,329

ENABLING ENVIRONMENT

Senegal’s National Malaria Control Program (NMCP) and the President’s Malaria Initiative (PMI) have worked closely together on their strategic plans for malaria control and prevention in Senegal. Within those plans, NetMark advocacy led to the adoption of a voucher-based targeted subsidies model as the strategy to be used by the NCMP and PMI for the distribution of both free and subsidized long-lasting insecticidal nets (LLINs). This voucher program is described below. NetMark’s strategy was to support commercial sales to those who could afford them as well as the distribution of subsidized or free nets to those who could not.

SUPPLY OF ITNs

Brands and Sales:
NetMark developed the commercial retail market for insecticide-treated nets (ITNs) and LLINs in Senegal. Currently four distributors sell the four different brands of LLINs (noted above) in retail outlets
throughout the country.

Retail Outlets/Accessibility:
ITNs are now sold as pharmacies, supermarkets, and gas station stores. In addition, NetMark has included the 546 district health committees’ pharmacies as LLIN retail outlets, creating a permanent and stable system to ensure availability of LLINs all over Senegal.

EQUITY – VOUCHER PROGRAM AND FREE NETS

Vouchers:
In 2005, NetMark carried out a pilot project to gauge the feasibility of a targeted subsidies program using vouchers in Senegal. The evaluation of this pilot identified the coverage potential offered by district health committee pharmacies for the voucher program. These outlets were already selling LLINs on a retail basis; the vouchers would simply be a variant of that retail approach, with retailers receiving payment from NetMark whenvouchers were redeemed. Accordingly, in 2006 under the PMI, NetMark initiated an expansion of the targeted subsidy program to include five regions and 546 district health committee pharmacies. Through May 2009, 583,000 pregnant women received vouchers to cover most or all of the cost of an LLIN, and 545,000 women exchanged these vouchers for LLINS – a redemption rate of over 95%.

Free Net Distribution:
In 2007 in Dakar, NetMark distributed full-price vouchers for LLINs to mothers of children under five. This free-net campaign in Dakar proved the logistical and monitoring advantages of a voucher-based mechanism for mass free net distribution. The voucher campaign was coordinated with that year’s annual micronutrients campaign. Vouchers were delivered door to door to mothers and caregivers of children between six months and five years of age; these vouchers could then be exchanged for LLINs at specific redemption sites. Of the more 207,000 vouchers distributed in Dakar that year, 199,500 were redeemed for an LLIN – a redemption rate of 97.3%.

In 2008, NetMark provided logistical and supervision support for the same type of effort in five other regions, with 700,000 free LLINs distributed. This targeted-subsidies mechanism continued to be used in campaigns executed by the NMCP and other partners with NetMark logistical support. In 2009, NetMark developed and distributed promotional materials in support of a national free- net distribution campaign providing 2,000,000 LLINs to children under five.

In total, 2.9 million free LLINs have been distributed in Senegal using the NetMark-designed voucher scheme.

HOUSEHOLD OWNERSHIP AND USE

NetMark conducted household surveys in Senegal in 2000 and 2004 and in conjunction with the Malaria Indicator Survey (MIS) in 2008. The samples consisted of 1000-1527 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five regions: Dakar, Thiès, Kaolack, Tambacounda, and St. Louis. Both urban and rural areas were included. The surveys measured change over time – due to NetMark as well as others, although NetMark provided the major inputs to ITN/LLIN promotion during this period.

Ownership of Nets and ITNs:
The percent of households owning at least one net (whether ITN or not) more than doubled from 2000 to 2008, from 31% of households in 2000 to 66% in 2008. The percent of households owning an ITN (including LLINs) rose even more steeply – from 6% in 2000 to 59% in 2008.
Net and ITN ownership was higher in rural areas than urban areas (80% in rural areas vs. 58% in urban areas owning any net; 71% vs. 52% owning an ITN). Ownership has consistently been higher in rural areas since 2000. Households in the lower socioeconomic status (SES) quintiles were more likely to own a net or ITN than those in the upper quintiles. This is a pattern that has continued since 2000. There has been a sharp increase in the proportion of treated nets in Senegal, and now the great majority of nets owned are not only ITNs but LLINs. In 2000, 70% of nets owned had never been treated, but by 2008, only 9% of nets owned had never been treated. In 2008 the vast majority of nets owned – 87% – were ITNs. Almost all of these were LLINs; 83% of all nets owned had long-lasting treatment on them.

Use by Vulnerable Groups:
The household members most likely to be using the nets were those most vulnerable to malaria: children under five – especially children under one – and pregnant women. Unfortunately, net-use data for 2008 cannot be compared to 2000 and 2004. In 2008, data collection was carried out in conjunction with the MIS, which had planned to start in September (during the rainy season), the same time of year that the prior NetMark surveys had been carried out. However, the MIS data collection was delayed until November-December, the beginning of the dry season. Net use is lower in the dry season, so usage levels are not directly comparable.

That being said, the proportion in 2008 of all children under five sleeping under a net (treated or not) the prior night was 30%; the proportion sleeping under an ITN was 26%. These rates are undoubtedly lower than during the rainy season when there are many mosquitoes. The proportion in 2008 of pregnant women sleeping under any net was 32%; the proportion sleeping under an ITN was 28%. For both children under five and pregnant women, there was little variation by urban-rural residence, and no clear trend by SES.

Overall Household Use:
The percent of nets used the prior night varied by source of net. Just over half (53%) of nets obtained free were used the prior night, compared with 61% of nets purchased without a voucher, and 77% of nets purchased with a voucher.

Households are using their nets for increasingly longer periods of time during the year. In 2000, nets were used on average for 5.8 months of the year; by 2008 the average duration was 6.6 months.

CONCLUSIONS

Senegal is in many ways a model country. Ownership of nets, and especially the ownership of ITNs and now LLINs, has risen steeply since 2000. The jump in ownership is testament to the success of the mixed model: a segmented market in which free, subsidized, and commercial nets are made available to households. Particularly noteworthy is that ITN ownership is higher among the lower socio-economic households, contrary to the trend in most other countries.

Although 2008 net-use rates (among nets owned) are not totally comparable to prior net-use data due to seasonal differences, a much higher proportion of children under five and pregnant women slept under an ITN in 2008 than in 2000 and 2004, even though usage rates are lower during the dry season when the 2008 data were collected. Within net/ITN-owning households, children under five and pregnant women are given priority for using the household net, and the average number of months per year that nets are used continues to increase. Distribution of nets using a voucher system appears to be an especially promising means of maximizing use of nets owned.



		SENEGAL NetMark was active in Senegal starting in 2002. While the Project works nationwide with its partners in Senegal, the NetMark targeted subsidies program has focused on seven regions: Thiès, Louga, Kaolack, Ziguinchor, Kolda, Dakar, and Fatick. NETMARK PARTNERS Palunet, Dawa Plus® and Sentinelle™ (began 2002) DNS, Permanet® (began 2005) SONY, OlysetNet® (began 2005) MAGU, IconLife® (began 2006) USAID Country Project Budget: $8,625,769 Commercial Partners’ Investment: $13,354,329 ENABLING ENVIRONMENT Senegal’s National Malaria Control Program (NMCP) and the President’s Malaria Initiative (PMI) have worked closely together on their strategic plans for malaria control and prevention in Senegal. Within those plans, NetMark advocacy led to the adoption of a voucher-based targeted subsidies model as the strategy to be used by the NCMP and PMI for the distribution of both free and subsidized long-lasting insecticidal nets (LLINs). This voucher program is described below. NetMark’s strategy was to support commercial sales to those who could afford them as well as the distribution of subsidized or free nets to those who could not. SUPPLY OF ITNs Brands and Sales: NetMark developed the commercial retail market for insecticide-treated nets (ITNs) and LLINs in Senegal. Currently four distributors sell the four different brands of LLINs (noted above) in retail outlets throughout the country. Retail Outlets/Accessibility: ITNs are now sold as pharmacies, supermarkets, and gas station stores. In addition, NetMark has included the 546 district health committees’ pharmacies as LLIN retail outlets, creating a permanent and stable system to ensure availability of LLINs all over Senegal. EQUITY – VOUCHER PROGRAM AND FREE NETS Vouchers: In 2005, NetMark carried out a pilot project to gauge the feasibility of a targeted subsidies program using vouchers in Senegal. The evaluation of this pilot identified the coverage potential offered by district health committee pharmacies for the voucher program. These outlets were already selling LLINs on a retail basis; the vouchers would simply be a variant of that retail approach, with retailers receiving payment from NetMark whenvouchers were redeemed. Accordingly, in 2006 under the PMI, NetMark initiated an expansion of the targeted subsidy program to include five regions and 546 district health committee pharmacies. Through May 2009, 583,000 pregnant women received vouchers to cover most or all of the cost of an LLIN, and 545,000 women exchanged these vouchers for LLINS – a redemption rate of over 95%. Free Net Distribution: In 2007 in Dakar, NetMark distributed full-price vouchers for LLINs to mothers of children under five. This free-net campaign in Dakar proved the logistical and monitoring advantages of a voucher-based mechanism for mass free net distribution. The voucher campaign was coordinated with that year’s annual micronutrients campaign. Vouchers were delivered door to door to mothers and caregivers of children between six months and five years of age; these vouchers could then be exchanged for LLINs at specific redemption sites. Of the more 207,000 vouchers distributed in Dakar that year, 199,500 were redeemed for an LLIN – a redemption rate of 97.3%. In 2008, NetMark provided logistical and supervision support for the same type of effort in five other regions, with 700,000 free LLINs distributed. This targeted-subsidies mechanism continued to be used in campaigns executed by the NMCP and other partners with NetMark logistical support. In 2009, NetMark developed and distributed promotional materials in support of a national free- net distribution campaign providing 2,000,000 LLINs to children under five. In total, 2.9 million free LLINs have been distributed in Senegal using the NetMark-designed voucher scheme. HOUSEHOLD OWNERSHIP AND USE NetMark conducted household surveys in Senegal in 2000 and 2004 and in conjunction with the Malaria Indicator Survey (MIS) in 2008. The samples consisted of 1000-1527 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five regions: Dakar, Thiès, Kaolack, Tambacounda, and St. Louis. Both urban and rural areas were included. The surveys measured change over time – due to NetMark as well as others, although NetMark provided the major inputs to ITN/LLIN promotion during this period. Ownership of Nets and ITNs: The percent of households owning at least one net (whether ITN or not) more than doubled from 2000 to 2008, from 31% of households in 2000 to 66% in 2008. The percent of households owning an ITN (including LLINs) rose even more steeply – from 6% in 2000 to 59% in 2008. Net and ITN ownership was higher in rural areas than urban areas (80% in rural areas vs. 58% in urban areas owning any net; 71% vs. 52% owning an ITN). Ownership has consistently been higher in rural areas since 2000. Households in the lower socioeconomic status (SES) quintiles were more likely to own a net or ITN than those in the upper quintiles. This is a pattern that has continued since 2000. There has been a sharp increase in the proportion of treated nets in Senegal, and now the great majority of nets owned are not only ITNs but LLINs. In 2000, 70% of nets owned had never been treated, but by 2008, only 9% of nets owned had never been treated. In 2008 the vast majority of nets owned – 87% – were ITNs. Almost all of these were LLINs; 83% of all nets owned had long-lasting treatment on them. Use by Vulnerable Groups: The household members most likely to be using the nets were those most vulnerable to malaria: children under five – especially children under one – and pregnant women. Unfortunately, net-use data for 2008 cannot be compared to 2000 and 2004. In 2008, data collection was carried out in conjunction with the MIS, which had planned to start in September (during the rainy season), the same time of year that the prior NetMark surveys had been carried out. However, the MIS data collection was delayed until November-December, the beginning of the dry season. Net use is lower in the dry season, so usage levels are not directly comparable. That being said, the proportion in 2008 of all children under five sleeping under a net (treated or not) the prior night was 30%; the proportion sleeping under an ITN was 26%. These rates are undoubtedly lower than during the rainy season when there are many mosquitoes. The proportion in 2008 of pregnant women sleeping under any net was 32%; the proportion sleeping under an ITN was 28%. For both children under five and pregnant women, there was little variation by urban-rural residence, and no clear trend by SES. Overall Household Use: The percent of nets used the prior night varied by source of net. Just over half (53%) of nets obtained free were used the prior night, compared with 61% of nets purchased without a voucher, and 77% of nets purchased with a voucher. Households are using their nets for increasingly longer periods of time during the year. In 2000, nets were used on average for 5.8 months of the year; by 2008 the average duration was 6.6 months. CONCLUSIONS Senegal is in many ways a model country. Ownership of nets, and especially the ownership of ITNs and now LLINs, has risen steeply since 2000. The jump in ownership is testament to the success of the mixed model: a segmented market in which free, subsidized, and commercial nets are made available to households. Particularly noteworthy is that ITN ownership is higher among the lower socio-economic households, contrary to the trend in most other countries. Although 2008 net-use rates (among nets owned) are not totally comparable to prior net-use data due to seasonal differences, a much higher proportion of children under five and pregnant women slept under an ITN in 2008 than in 2000 and 2004, even though usage rates are lower during the dry season when the 2008 data were collected. Within net/ITN-owning households, children under five and pregnant women are given priority for using the household net, and the average number of months per year that nets are used continues to increase. Distribution of nets using a voucher system appears to be an especially promising means of maximizing use of nets owned.		Senegal 2008 Household Survey Report (PDF, 1.23 MB) Senegal 2008 Household Survey Report en Francais (PDF, 1.23 MB)