Commercial Partnership in Senegal Protects Pregnant
Women and Children from Malaria and Boosts Local Businesses
An innovative approach to fighting malaria in Senegal is not only helping to protect pregnant women and children from the deadly disease—but it is bolstering local businesses and equipping Senegal to continue this antimalaria effort when donor dollars are no longer available.
Malaria
kills more than 2 million people in Africa every year. Insecticide-treated
mosquito bed nets (ITNs) are one of the most effective methods for
preventing the disease. The NetMark Project, which is managed by AED
and funded by USAID, has operated in seven African countries, creating
sustainable national markets for ITNs through partnerships with commercial
net and insecticide manufacturers and their African distributors and
retailers. The aim is to reduce malaria by increasing the use of ITNs.
NetMark and its partners jointly invest to build markets by increasing
demand for ITNs through education and promotion. Growing demand and
increased competition result in ITNs costing less and being more widely
available.
AED developed this joint-risk, joint investment partnership model, called Full Market Impact™, to support ITN distribution efforts and create sustainable distribution and promotion networks that will continue to function over the long term, even when donor funding subsides. The model segments the market and into fully commercial, pre-commercial and non-commercial targets, and employs a range of strategies to efficiently achieve maximum public health impact.
“With this approach, those who can’t pay for the nets are reached through targeted subsidy programs, while commercial nets are made available to the vast numbers of people who can and prefer to purchase the size, shape and color ITN they want without having to go to a public clinic,” said David McGuire, the Director of NetMark. “This helps spend tax dollars more effectively and helps set up African businesses to provide access to ITNs for those not reached by free distribution efforts,” he said. “We have seen ITN use increase by double digits with this approach because, as research shows, people who pay for something are more likely to use it,” McGuire added.
Overall, NetMark is making a big impact:
• The number of people protected from malaria by ITNs has risen by an estimated 27 million since 2000, when NetMark began operating.
• NetMark has helped teach more than 100 million people about the dangers of malaria and how ITNs can prevent it. NetMark’s national public education and promotion efforts have boosted ITN sales and use of nets distributed by both the public and commercial sectors.
• NetMark has benefited the poor as much or more than the wealthiest groups. In Ghana, Nigeria, Senegal and Zambia, the poorest 40% of the population own 32% of the nets. In contrast, 27% of the nets distributed by the public sector (usually at highly subsidized prices) go to the wealthiest 20% of households.
• Taxes and tariffs on ITNs have been reduced or eliminated in all of NetMark’s target countries (Ethiopia, Ghana, Mali, Nigeria, Senegal, Uganda and Zambia).
• Since 1999, NetMark has developed partnerships with 38 African and nine international commercial partners who have invested more than $55 million in country programs and restructured to develop and support retail markets. This means the commercial sector has invested about $1.25 for every dollar invested by USAID.
• NetMark has helped make ITNs available in 6,500 outlets since 2002.
“This partnership model is saving lives and, on top of that, it’s improving the economy right where people live,” said McGuire. “And that ultimately will be one of the most important factors in alleviating poverty in rural Africa.”
In Senegal—where malaria kills 8,000 people a year, mostly women and children—NetMark has been co-investing with the commercial sector to develop national ITN markets since 2002. So far:
• Commercial partners have invested nearly $8.8 million, surpassing USAID's investment by about $3.1 million. The partners also developed and launched six new ITN brands.
• NetMark partners have sold about 2.3 million ITNs.
• Senegal’s leading distributor, launched when NetMark began operating in the country, now employs more than 12 people.
• ITN ownership and use has risen substantially. The percentage of households that own an ITN surged from 8% in 2000 to 36% in 2006. In the same period, use by pregnant women jumped from 5% to 32%, and use by children under age five rose from 5% to 28%.
The President’s Malaria Initiative (PMI), launched by President Bush in 2005, set targets to ensure that 85% of pregnant women and children in 15 African countries, including Senegal, will be sleeping under ITNs. Many in the development community thought that the best way to do this is to distribute free nets to everyone. However, NetMark, which had already built up Senegal’s ITN markets, recognized that giving free nets to everyone was not sustainable and would wipe out the country’s ITN distributors and retailers, hurting local economies. The loss of those businesses likely would leave Senegal dependent on donors to provide ITNs and hamper the fight against malaria when donor dollars stop flowing.
In May 2007, NetMark began using an alternative approach that allows PMI to rapidly increase net coverage without undercutting Senegal’s ITN markets. Through a partnership between NetMark and the Ministry of Health, health workers gave pregnant women and caregivers of children under five coupons for long-lasting insecticide-treated nets (LLINs) that they redeem at community-owned drugstores in health facilities and at other retail outlets. The women and caregivers pay only about $2-$3 for a $7-$8 net. They also can choose the net’s size, shape and color rather than receive a net selected by donors.
The approach spares the public sector some of the logistical difficulties in procuring and distributing bulky nets and creates an opportunity for health workers to educate pregnant women and caregivers about malaria. At the same time, Senegalese distributors and retailers can expand distribution and create sustainable outlets that will remain beyond the PMI campaign.
In just five months, more than 97% of the nearly 87,000 coupons distributed to pregnant women and caregivers of children under age five have been redeemed. In addition, about 198 community-owned drugstores added the nets to their inventory to meet demand generated by the coupon campaign. Interestingly, most women opt for the most expensive nets because they prefer the larger size and conical design which is easier to hang.
“Critics have said the system is complicated, time-consuming and can’t achieve results that are comparable to free distribution campaigns,” said Fana Sakho, NetMark’s Senegal Manager. “But the results show that the approach is fast, cost-efficient for donors and, most important, creates a sustainable market that serves family members who aren’t targeted by the malaria initiative but are also vulnerable to malaria,” said Ms. Sakho.
Oumy Kebe, a mother from Sagatta in the district of Kebemar, said, “The long-lasting net is keeping us safe from malaria. Last year we had three cases of malaria in my family. But this year, we haven’t had any cases of malaria yet.” She added, “Besides, the net helps us sleep better.”
Aissatou Camara, a pregnant woman from Diakhao in the district of Thies, said, “The net is affordable. For only $2, we get a good quality net. The net keeps me safe from malaria, which is not good for pregnant women.”
Health workers are seeing results. “The number of people with malaria has really decreased from last year,” said Ismaila Thiandoum, a nurse at the health post in Pambal in the district of Tivavouane. “There were 66 cases of malaria admitted at the health post last year, compared to only 15 this year,” he noted.
Ibou Mbengue, a nurse at a health center in Sagatta, said the program also helps the community-owned drugstore in the health post keep the nets in stock so that they are readily available. The program “decreases the number of people with malaria. It’s saving more lives,” he said.
Thiandoum and Mbengue also noted that the program’s impact extends beyond malaria. Mbengue said that because the nets draw more people to the health post, prenatal visits and vaccinations have increased from 2006. The percentage of the pregnant women in his health post’s coverage area who received prenatal care rose from 90% to 100%--and a number of pregnant women outside the coverage area also received prenatal care at the post. The percentage of children in the post’s coverage area who received vaccinations rose from 75% to 88%.
In addition, “because of the program, our volume of work has decreased a lot this year,” said Thiandoum. “Malaria constitutes 30% of the reasons for visiting the health post.”
Oumar Boye, director of a net distributor in Dakar, is pleased with the program’s approach. "What is gratifying about what we’re doing is that we’re helping save lives and helping the economy and still making some profit to continue the business,” he said.
“We don't want the program to stop,” Thiandoum said. “We want the program to continue forever.”
November 11, 2007
