Experience of targeting subsidies on insecticide-treated nets: what do we know and what are the knowledge gaps?


Eve Worrall, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel.: +44 20 79272142; Fax +44 20 76375391; E-mail: eve.worrall@lshtm.ac.uk
Jenny Hill, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Tel.: +44 151 705 3216; Fax: +44 151 705 3329, E-mail: jennyhil@liv.ac.uk (corresponding author)
Jayne Webster and Julia Mortimer, Malaria Knowledge Programme, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel.: +44 20 7927 2648/2216; Fax: +44 20 7 580 9075;
E-mail: jayne.webster@lshtm.ac.uk, julia.mortimer@lshtm.ac.uk


Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM ‘Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa’ promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM ‘Workshop on mapping models for delivering ITNs through targeted subsidies’ held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.