Zambia

ZAMBIA

NetMark was active in Zambia between 2001 and 2004. The program was terminated two years early when the government of Zambia decided to support universal distribution of highly subsidized and free ITNs. Nevertheless, the targeted subsidy voucher program was active in seven out of nine provinces. NetMark Partners included:
• EcoMed, K-O Net, (began 2003)
• Melcome, IcoNet, (began 2004)
• Agpack, FenNet, (began 2001)

USAID Country Project Budget: $ 1,428,000
Commercial Partners’ Investment: $ 1,090,174

ENABLING ENVIRONMENT

Zambia employs a mix of delivery mechanisms for insecticide-treated nets (ITNs) to target different geographic, economic, and biologically vulnerable segments of society. Mechanisms range from straight commercial sales by retail traders to a variety of targeted subsidy schemes, including a discount voucher program for pregnant women in urban areas and direct subsidized sales through antenatal clinics in rural areas. There are also a variety of subsidized revolving funds by District Health Management Teams and NGOs, and finally, free distributions to the most vulnerable populations, including people living with AIDS and orphan-headed households. In 2004, ITN distribution to secondary boarding schools and health facilities and employer-based ITN schemes in the agriculture and mining sectors were launched.

The Society for Family Health (SFH) introduced Powernet (a bundled net) from 2000-2002, and then Safenite (a long-lasting insecticidal net, or LLIN) in 2002, on a commercial basis. SFH later introduced Mama Safenite (also an LLIN) in 2003, to be sold on a subsidized basis from clinics. SFH had supported a program to sell Powernet in health centers in Kitwe (a program that is now ended), and has run the Mama Safenite program since 2003 in Kaoma, and since 2004 in Mansa.

Since 1999 UNICEF and the National Malaria Control Program have given ITNs to Mansa for the Community-Based Malaria Prevention and Control Project for sale at subsidized prices at health centers.

SUPPLY OF ITNs

Brands and Sales:
NetMark helped develop the retail market for ITNs in Zambia. A total of 900,915 ITNs were sold by NetMark commercial partners in retail outlets in Zambia between 2001 and 2004. NetMark partners expanded distribution, forged links with organizations and institutions as dedicated clients, and invested their own funds to grow their nascent businesses. Ultimately, the government of Zambia decided to take advantage of massive donor funding to move away from a mixed model.

Retail Outlets/Accessibility:
NetMark began its Zambia operations in 2001, working with distributors to sell K-O Net, Fennet, and ( in 2004) Iconet on a fully commercial basis. The National Malaria Control Program (NMCP) sought a mixed model of free, subsidized, and commercial ITNs and divided the country among donors. NetMark and its partners focused on areas along the “line of rail” from Lusaka to Kitwe, including urban centers such as Kabwe. In October 2002, NetMark and the NMCP piloted a discount voucher program for pregnant women getting antenatal care in government health facilities. The voucher allowed them to purchase an ITN from a participating retail outlet. SFH and NetMark also made treatment kits available. SFH established its own PowerChem brand, while NetMark supported fully commercial brands: Fendona, FenNet, K-O Net, K-O Tab, and, in 2004, Iconet.

ITN distribution was supported by promotional activities. NetMark heavily promoted ITNs via television, national and community radio, road shows, and women’s groups. In Lusaka and Kitwe, NetMark also conducted workplace/factory promotion. The Society for Family Health advertised its Safenite brand on television as well. The NMCP developed and distributed materials to clinics country-wide, especially during child-health weeks during the first weeks of July and first week of December. During those same weeks there were also promotions on the re-treatment and use of ITNs on both radio and television.

In 2004 USAID decided that NetMark had sufficiently demonstrated the viability of a commercial market and asked it to phase out in 2005 with its commercial partners continuing on their own. In 2005, the new leadership of the NMCP decided it had enough donor funds to enable it to support universal distribution of highly subsidized and free ITNs. NetMark’s partners continued to sell, but were not able to greatly increase their market share. The discount voucher program was successfully established and commercial partners remained enthusiastic supporters of it.

During the project period of performance, NetMark formal partners expanded their distribution, creating 178 new retail sales locations. By 2005, new distributors were entering the ITN market, further increasing the number of commercially available brands and distribution outlets.

Price:
By 2006, retail price reductions of up to 30% for ITNs were achieved.

EQUITY – VOUCHER PROGRAM AND FREE NETS

In 2002, NetMark created and piloted the targeted subsidy voucher program in Zambia and achieved a 70% redemption rate among pregnant women visiting antenatal clinics in Lusaka and Kitwe. The voucher program eventually rolled out in seven of nine provinces. ExxonMobil and UNICEF funded some of the voucher programs, which were carried out in a number of districts that included sites in the household survey areas: Lusaka, Kitwe, and Choma. Over 153,000 vouchers were distributed with a redemption rate of 78% achieved.

HOUSEHOLD OWNERSHIP AND USE

NetMark conducted household surveys in Zambia in 2000 and 2004. (As noted, NetMark withdrew its program in 2004 when Zambia decided to convert entirely to distributing donor-supplied nets. Therefore, there was no 2008 survey as in other countries.) The 2000 and 2004 sample consisted of 1000-2000 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five sites: Lusaka, Kitwe, Choma, Mansa, and Kaoma, plus the surrounding rural areas, up to 200 kilometers away in order to include both urban and rural areas. 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:

Between 2000 and 2004, awareness of treated nets increased significantly, from 51% to 88%. Similarly, the percentage of households owning a net nearly doubled, from 27% to 50%. ITN ownership jumped nearly six-fold, increasing from 6% in 2000 to 35% in 2004.

Net and ITN ownership increased with socio-economic status in both years. Measures need to be taken to increase equity of ownership. Ownership was also substantially higher in urban areas than rural.

Use by Vulnerable Groups:
Between 2000 and 2004, the percent of children under five sleeping under
a net the night before the survey doubled, and the percent sleeping under an ITN rose even more steeply. The percent of young children under
a net would undoubtedly have been higher had the surveys been administered during the rainy season, when mosquito density is high. Zambia was the only country where the NetMark survey took place during the dry season, since baseline data was needed prior to launch of NetMark activities and could not wait until the rainy season.

The percent of pregnant women sleeping under a net increased five-fold, to 22%. In 2000, no pregnant woman in the sample had slept under an ITN the previous night but in 2004, 14% had.

Use of nets and ITNs by children and pregnant women was much higher in urban areas and the higher SES strata, reflecting the overall pattern of net/ITN ownership.

Overall Household Use:
Net use is lower in the dry season than the rainy season; nevertheless, two out of three nets were used (67% in 2000 and 62% in 2004) by someone in the household the night before the survey.

Nets that were acquired free of charge were used less (46%) than nets that had been paid for (63%).

CONCLUSIONS

Survey results showed dramatic improvements between 2000 and 2004 in ownership of mosquito nets and ITNs, use of nets by vulnerable groups, net-treatment practices, and knowledge and beliefs about mosquitoes and malaria.

In 2004, achieving equity in ITN ownership and use was an important challenge. As more free and low-cost nets have been made available since then, it is important to measure what progress has been made toward achieving and maintaining equity.

ITNs should be used year-round, and most net-owning families in Zambia were using their nets even in the dry season. Within net-owning households, the youngest children and pregnant women were given preference for sleeping under a net. Maintaining positive use behaviors should continue to be a priority for ITN programs, along with increasing the number of households owning nets.



r	ZAMBIA NetMark was active in Zambia between 2001 and 2004. The program was terminated two years early when the government of Zambia decided to support universal distribution of highly subsidized and free ITNs. Nevertheless, the targeted subsidy voucher program was active in seven out of nine provinces. NetMark Partners included: • EcoMed, K-O Net, (began 2003) • Melcome, IcoNet, (began 2004) • Agpack, FenNet, (began 2001) USAID Country Project Budget: $ 1,428,000 Commercial Partners’ Investment: $ 1,090,174 ENABLING ENVIRONMENT Zambia employs a mix of delivery mechanisms for insecticide-treated nets (ITNs) to target different geographic, economic, and biologically vulnerable segments of society. Mechanisms range from straight commercial sales by retail traders to a variety of targeted subsidy schemes, including a discount voucher program for pregnant women in urban areas and direct subsidized sales through antenatal clinics in rural areas. There are also a variety of subsidized revolving funds by District Health Management Teams and NGOs, and finally, free distributions to the most vulnerable populations, including people living with AIDS and orphan-headed households. In 2004, ITN distribution to secondary boarding schools and health facilities and employer-based ITN schemes in the agriculture and mining sectors were launched. The Society for Family Health (SFH) introduced Powernet (a bundled net) from 2000-2002, and then Safenite (a long-lasting insecticidal net, or LLIN) in 2002, on a commercial basis. SFH later introduced Mama Safenite (also an LLIN) in 2003, to be sold on a subsidized basis from clinics. SFH had supported a program to sell Powernet in health centers in Kitwe (a program that is now ended), and has run the Mama Safenite program since 2003 in Kaoma, and since 2004 in Mansa. Since 1999 UNICEF and the National Malaria Control Program have given ITNs to Mansa for the Community-Based Malaria Prevention and Control Project for sale at subsidized prices at health centers. SUPPLY OF ITNs Brands and Sales: NetMark helped develop the retail market for ITNs in Zambia. A total of 900,915 ITNs were sold by NetMark commercial partners in retail outlets in Zambia between 2001 and 2004. NetMark partners expanded distribution, forged links with organizations and institutions as dedicated clients, and invested their own funds to grow their nascent businesses. Ultimately, the government of Zambia decided to take advantage of massive donor funding to move away from a mixed model. Retail Outlets/Accessibility: NetMark began its Zambia operations in 2001, working with distributors to sell K-O Net, Fennet, and ( in 2004) Iconet on a fully commercial basis. The National Malaria Control Program (NMCP) sought a mixed model of free, subsidized, and commercial ITNs and divided the country among donors. NetMark and its partners focused on areas along the “line of rail” from Lusaka to Kitwe, including urban centers such as Kabwe. In October 2002, NetMark and the NMCP piloted a discount voucher program for pregnant women getting antenatal care in government health facilities. The voucher allowed them to purchase an ITN from a participating retail outlet. SFH and NetMark also made treatment kits available. SFH established its own PowerChem brand, while NetMark supported fully commercial brands: Fendona, FenNet, K-O Net, K-O Tab, and, in 2004, Iconet. ITN distribution was supported by promotional activities. NetMark heavily promoted ITNs via television, national and community radio, road shows, and women’s groups. In Lusaka and Kitwe, NetMark also conducted workplace/factory promotion. The Society for Family Health advertised its Safenite brand on television as well. The NMCP developed and distributed materials to clinics country-wide, especially during child-health weeks during the first weeks of July and first week of December. During those same weeks there were also promotions on the re-treatment and use of ITNs on both radio and television. In 2004 USAID decided that NetMark had sufficiently demonstrated the viability of a commercial market and asked it to phase out in 2005 with its commercial partners continuing on their own. In 2005, the new leadership of the NMCP decided it had enough donor funds to enable it to support universal distribution of highly subsidized and free ITNs. NetMark’s partners continued to sell, but were not able to greatly increase their market share. The discount voucher program was successfully established and commercial partners remained enthusiastic supporters of it. During the project period of performance, NetMark formal partners expanded their distribution, creating 178 new retail sales locations. By 2005, new distributors were entering the ITN market, further increasing the number of commercially available brands and distribution outlets. Price: By 2006, retail price reductions of up to 30% for ITNs were achieved. EQUITY – VOUCHER PROGRAM AND FREE NETS In 2002, NetMark created and piloted the targeted subsidy voucher program in Zambia and achieved a 70% redemption rate among pregnant women visiting antenatal clinics in Lusaka and Kitwe. The voucher program eventually rolled out in seven of nine provinces. ExxonMobil and UNICEF funded some of the voucher programs, which were carried out in a number of districts that included sites in the household survey areas: Lusaka, Kitwe, and Choma. Over 153,000 vouchers were distributed with a redemption rate of 78% achieved. HOUSEHOLD OWNERSHIP AND USE NetMark conducted household surveys in Zambia in 2000 and 2004. (As noted, NetMark withdrew its program in 2004 when Zambia decided to convert entirely to distributing donor-supplied nets. Therefore, there was no 2008 survey as in other countries.) The 2000 and 2004 sample consisted of 1000-2000 women of reproductive age (15-49) who were pregnant or caring for a child under five, from five sites: Lusaka, Kitwe, Choma, Mansa, and Kaoma, plus the surrounding rural areas, up to 200 kilometers away in order to include both urban and rural areas. 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: Between 2000 and 2004, awareness of treated nets increased significantly, from 51% to 88%. Similarly, the percentage of households owning a net nearly doubled, from 27% to 50%. ITN ownership jumped nearly six-fold, increasing from 6% in 2000 to 35% in 2004. Net and ITN ownership increased with socio-economic status in both years. Measures need to be taken to increase equity of ownership. Ownership was also substantially higher in urban areas than rural. Use by Vulnerable Groups: Between 2000 and 2004, the percent of children under five sleeping under a net the night before the survey doubled, and the percent sleeping under an ITN rose even more steeply. The percent of young children under a net would undoubtedly have been higher had the surveys been administered during the rainy season, when mosquito density is high. Zambia was the only country where the NetMark survey took place during the dry season, since baseline data was needed prior to launch of NetMark activities and could not wait until the rainy season. The percent of pregnant women sleeping under a net increased five-fold, to 22%. In 2000, no pregnant woman in the sample had slept under an ITN the previous night but in 2004, 14% had. Use of nets and ITNs by children and pregnant women was much higher in urban areas and the higher SES strata, reflecting the overall pattern of net/ITN ownership. Overall Household Use: Net use is lower in the dry season than the rainy season; nevertheless, two out of three nets were used (67% in 2000 and 62% in 2004) by someone in the household the night before the survey. Nets that were acquired free of charge were used less (46%) than nets that had been paid for (63%). CONCLUSIONS Survey results showed dramatic improvements between 2000 and 2004 in ownership of mosquito nets and ITNs, use of nets by vulnerable groups, net-treatment practices, and knowledge and beliefs about mosquitoes and malaria. In 2004, achieving equity in ITN ownership and use was an important challenge. As more free and low-cost nets have been made available since then, it is important to measure what progress has been made toward achieving and maintaining equity. ITNs should be used year-round, and most net-owning families in Zambia were using their nets even in the dry season. Within net-owning households, the youngest children and pregnant women were given preference for sleeping under a net. Maintaining positive use behaviors should continue to be a priority for ITN programs, along with increasing the number of households owning nets.	Zambia 2004 Household Survey Report (PDF, 689 KB)