Uganda

NetMark was active in Uganda from 2003 to 2009. The program was implemented across the country with a focus on commercially viable urban areas.

USAID Country Project Budget: $ 3,655,000
Commercial Partners’ Investment: $13,033,112

NETMARK PARTNERS

SUPPLY OF COMMERCIAL ITNS

Brands and Sales:
Commercial sales of insecticide-treated nets (ITNs) grew from approximately 70,000 pieces in 2002 to over 1,000,000 pieces in 2008. NetMark started with two formal partners in 2002, and by 2009 was in partnership with six formal and three informal ITN distributors. The number of brands supported rose from one in 2002 to ten in 2009. Five of these are long-lasting insecticidal nets (LLINs).

Retail Outlet/Accessibility:
At least 30,000 retail outlets across Uganda stocked ITNs in 2008.
The numeric distribution of ITN sales points across the country grew
from almost zero in 2002 to 15% of outlets in 2008. This means that
one out of every six retail outlets in Uganda routinely stocks ITNs.

Price:
The average ITN price dropped from $8.00 in 2002 to $5.50 in 2009.
The prices of LLINs are also competitive at an average of $6.50.
NetMark’s activities have also had an effect on the development of
informal players in the net market. Untreated nets were almost
non-existent on the market in 2002. Their prices dropped from an average
of $4.50 to $2.50 since 2002.

Local Production of ITNs:

NetMark supported Cooper (U) Limited to launch local stitching of ITNs
in February 2007. By the end of 2008, over 60 people were employed at
the facility, producing and selling 20,000 nets per month. In 2009, NetMark gave giving technical and financial assistance to Cooper to upgrade to LLIN stitching, and as a result Cooper and Clarke signed a Memorandum of Understanding that has enabled Cooper to produce DuraNet® in Uganda starting in August 2009.

Support for Re-treatment:

NetMark also provided financial and logistical support to the Ugandan Ministry of Health in the annual national mass net re-treatment campaigns. Through the end of 2004, a total of 648,384 nets were re-treated through these campaigns.

HOUSEHOLD OWNERSHIP AND USE

NetMark conducted household surveys in Uganda in 2000 and 2006. The sample consisted of 2122 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five sites:

Kampala, Masaka, Mbarara, Hoima, and Soroti. Each site consisted of the city plus surrounding rural areas in several districts up to 200 km from the urban center. The surveys measured change over time – due to NetMark as well as others, although NetMark was the major project devoted to ITN promotion during this period.

Ownership of Nets and ITNs
In 2000, less than one in four women surveyed had ever heard of
treated nets, but by 2006, awareness of treated nets was nearly
universal. Substantially more households owned at least one ITN in
2006 than in 2000. Over 20% of households owned an ITN in 2006, up
from only 1% in 2000. ITN ownership rates were similar in urban (25%)
and rural areas (20%), but there were large differences by site.

Net ownership was strongly associated with socio-economic status
(SES), increasing steeply in the two highest quintiles. However, the
poorer groups made more progress in net ownership between the
two surveys, resulting in increased equity in 2006.

Most nets in Uganda were purchased from commercial sources,
even among the poorest groups, indicating that people valued nets and
were willing to pay for them.

Use by Vulnerable Groups:
Uganda had virtually no ITNs in 2000, and since then the numbers of
pregnant women and children under five sleeping under an ITN have been growing.

Patterns in use by children and pregnant women followed patterns
in ownership: net use was higher in urban areas in both years, but
showed greater improvement in rural areas; net and ITN use was highest
in Soroti and lowest in Masaka; and ITN use was much more equitable
(as measured by SES or urban/rural) than net use.

Overall Household Use:
In both years, most nets owned were used, although the percent of
nets owned that had been used in the night prior to the survey dropped
from 92% in 2000 to 84% in 2006. Nets that were free and nets that
were paid for were used at the same rate – 84% – but nets that
were received as gifts were used less: 69%.

The main reasons given for non-use in 2006 were that the net was too
hot (21% of unused nets) or that it was not necessary at that time,
perhaps due to few mosquitoes (16%). Although ITNs were rated higher than other mosquito-control products, an important minority (particularly in Kampala and among the wealthier respondents) had reservations about the safety of the insecticide.

CONCLUSIONS

Ownership of ITNs increased greatly from 2000 to 2006, as did ITN use by children and pregnant women. Ownership and use of ITNs were much more equitable than ownership and use of untreated nets. Increased net ownership and equity suggest that strengthening the private sector to make nets available and affordable has been effective and should be continued until ownership in rural and poorer households reaches the levels of their urban and wealthier counterparts. The majority of nets were obtained through the commercial sector, even in rural areas and among the poorest households, demonstrating the importance of the commercial sector in increasing coverage. At the same time, a greater proportion of rural and poor households obtained their nets/ITNs from non-commercial sources. This shows the value of an approach that combines commercial activity with targeted free and highly subsidized net distribution. The number of net brands available in Uganda increased exponentially since 2000, further evidence of the dynamic commercial market.

All household members were much more likely to sleep under an ITN in 2006 than in 2000, and differences by urban/rural and socio-economic status are modest. But differences by site are substantial, particularly among pregnant women, and suggest a need for targeted distribution of ITNs and supporting communication, such as through counseling and vouchers at antenatal clinics.



		UGANDA NetMark was active in Uganda from 2003 to 2009. The program was implemented across the country with a focus on commercially viable urban areas. USAID Country Project Budget: $ 3,655,000 Commercial Partners’ Investment: $13,033,112 NETMARK PARTNERS SUPPLY OF COMMERCIAL ITNS Brands and Sales: Commercial sales of insecticide-treated nets (ITNs) grew from approximately 70,000 pieces in 2002 to over 1,000,000 pieces in 2008. NetMark started with two formal partners in 2002, and by 2009 was in partnership with six formal and three informal ITN distributors. The number of brands supported rose from one in 2002 to ten in 2009. Five of these are long-lasting insecticidal nets (LLINs). Retail Outlet/Accessibility: At least 30,000 retail outlets across Uganda stocked ITNs in 2008. The numeric distribution of ITN sales points across the country grew from almost zero in 2002 to 15% of outlets in 2008. This means that one out of every six retail outlets in Uganda routinely stocks ITNs. Price: The average ITN price dropped from $8.00 in 2002 to $5.50 in 2009. The prices of LLINs are also competitive at an average of $6.50. NetMark’s activities have also had an effect on the development of informal players in the net market. Untreated nets were almost non-existent on the market in 2002. Their prices dropped from an average of $4.50 to $2.50 since 2002. Local Production of ITNs: NetMark supported Cooper (U) Limited to launch local stitching of ITNs in February 2007. By the end of 2008, over 60 people were employed at the facility, producing and selling 20,000 nets per month. In 2009, NetMark gave giving technical and financial assistance to Cooper to upgrade to LLIN stitching, and as a result Cooper and Clarke signed a Memorandum of Understanding that has enabled Cooper to produce DuraNet® in Uganda starting in August 2009. Support for Re-treatment: NetMark also provided financial and logistical support to the Ugandan Ministry of Health in the annual national mass net re-treatment campaigns. Through the end of 2004, a total of 648,384 nets were re-treated through these campaigns. HOUSEHOLD OWNERSHIP AND USE NetMark conducted household surveys in Uganda in 2000 and 2006. The sample consisted of 2122 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five sites: Kampala, Masaka, Mbarara, Hoima, and Soroti. Each site consisted of the city plus surrounding rural areas in several districts up to 200 km from the urban center. The surveys measured change over time – due to NetMark as well as others, although NetMark was the major project devoted to ITN promotion during this period. Ownership of Nets and ITNs In 2000, less than one in four women surveyed had ever heard of treated nets, but by 2006, awareness of treated nets was nearly universal. Substantially more households owned at least one ITN in 2006 than in 2000. Over 20% of households owned an ITN in 2006, up from only 1% in 2000. ITN ownership rates were similar in urban (25%) and rural areas (20%), but there were large differences by site. Net ownership was strongly associated with socio-economic status (SES), increasing steeply in the two highest quintiles. However, the poorer groups made more progress in net ownership between the two surveys, resulting in increased equity in 2006. Most nets in Uganda were purchased from commercial sources, even among the poorest groups, indicating that people valued nets and were willing to pay for them. Use by Vulnerable Groups: Uganda had virtually no ITNs in 2000, and since then the numbers of pregnant women and children under five sleeping under an ITN have been growing. Patterns in use by children and pregnant women followed patterns in ownership: net use was higher in urban areas in both years, but showed greater improvement in rural areas; net and ITN use was highest in Soroti and lowest in Masaka; and ITN use was much more equitable (as measured by SES or urban/rural) than net use. Overall Household Use: In both years, most nets owned were used, although the percent of nets owned that had been used in the night prior to the survey dropped from 92% in 2000 to 84% in 2006. Nets that were free and nets that were paid for were used at the same rate – 84% – but nets that were received as gifts were used less: 69%. The main reasons given for non-use in 2006 were that the net was too hot (21% of unused nets) or that it was not necessary at that time, perhaps due to few mosquitoes (16%). Although ITNs were rated higher than other mosquito-control products, an important minority (particularly in Kampala and among the wealthier respondents) had reservations about the safety of the insecticide. CONCLUSIONS Ownership of ITNs increased greatly from 2000 to 2006, as did ITN use by children and pregnant women. Ownership and use of ITNs were much more equitable than ownership and use of untreated nets. Increased net ownership and equity suggest that strengthening the private sector to make nets available and affordable has been effective and should be continued until ownership in rural and poorer households reaches the levels of their urban and wealthier counterparts. The majority of nets were obtained through the commercial sector, even in rural areas and among the poorest households, demonstrating the importance of the commercial sector in increasing coverage. At the same time, a greater proportion of rural and poor households obtained their nets/ITNs from non-commercial sources. This shows the value of an approach that combines commercial activity with targeted free and highly subsidized net distribution. The number of net brands available in Uganda increased exponentially since 2000, further evidence of the dynamic commercial market. All household members were much more likely to sleep under an ITN in 2006 than in 2000, and differences by urban/rural and socio-economic status are modest. But differences by site are substantial, particularly among pregnant women, and suggest a need for targeted distribution of ITNs and supporting communication, such as through counseling and vouchers at antenatal clinics.
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