The impact of malaria is worst for the poor and marginalised. Insecticide-treated mosquito nets (ITNs) are a practical malaria control tool, but their spread across Africa has been slow. Can social marketing increase ownership of nets without decreasing equity? A study in Morogoro Region, southern Tanzania suggests that the reverse may in fact be true.

Researchers at the Ifakara Health Research and Development Centre point out that the target of 60 percent coverage of ITNs by 2005 set at the Abuja summit in 2000 seems increasingly out of reach. The spread of net usage has been slowed by perceived difficulties in delivering insecticide re-treatment and by uncertainties about the best way to distribute nets in poor rural areas of Africa.

ITNs are probably too expensive for most people at risk of malaria, so health agencies are looking for ways to reduce prices through subsidies. Social marketing – where commercial marketing methods are applied for a health gain without a profit motive – offers a way to increase demand for nets whilst also subsidising prices. Good social marketing uses intense, well-informed promotion. It ca improve access through a subsidised distribution network. But are subsidies sustainable? Is social marketing the best way to use resources? Most importantly, because nets are sold, rather than given away for free, does social marketing increase inequity?

Before the start of a social marketing programme, the researchers asked about 12,000 household heads whether they owned nets and other assets, such as a tin roof, radio or bicycle. They developed a socio-economic score for each household, then repeated the survey three years later. Between the first and the second survey:

• The proportion of households with at least one net increased from 37 to 73 percent.
• Net ownership rose from 20 to 54 percent among the poorest households and from 63 to 92 percent among the least poor.
• The ratio of net ownership in the poorest to the least poor households increased from 0.3 to 0.6.

These results suggest that equity improved over the three years. The researchers acknowledge that the private sector, which was very active at the time of the study, probably helped the increase in net ownership. There is a dynamic market for mosquito nets in Tanzania, which is reaching further and futher into rural communities. Recommendations for sustaining this rate of improvement in equity of net ownership include:

• continuing the efforts of the ongoing social marketing campaign
• tailoring more effectively the campaign’s promotional messages
• researching the characteristics of non-users
• building on the opportunities for large-scale distribution provided by the private sector
• investigating other ways to help the poorest to purchase nets, such as the voucher scheme currently under development in Tanzania.

Source(s):
‘Mosquito nets and the poor: can social marketing redress inequities in access?’, Tropical Medicine and International Health 9(10): 1121-1126, by R. Nathan, et al., 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: Government of the United Republic of Tanzania; Swiss Agency for Development and Co-operation; Centres for Disease Control and Prevention; Swiss National Science Foundation; World Health Organization; Bill and Melinda Gates Foundation; US Agency for International Development

id21 Research Highlight: 31 May 2005

Further Information:
Rose Nathan
Ifakara Health Research and Development Centre
PO Box 53
Ifakara
Tanzania

Contact the contributor: rosenathan2001@yahoo.co.uk

Ifakara Health Research and Development Centre, Tanzania

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