Scaling-up coverage with insecticide-treated nets against malaria in Africa: who should pay?

Curtis, C; Maxwell, C; Lemnge, M; Kilama, WL; Steketee, RW; Hawley, WA; Bergevin, Y; Campbell, CC; Sachs, J; Teklehaimanot, A; Ochola, S; Guyatt, H; Snow, RW; (2003) Scaling-up coverage with insecticide-treated nets against malaria in Africa: who should pay? The Lancet infectious diseases, 3 (5). pp. 304-7. ISSN 1473-3099 DOI:

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Insecticide-treated nets (ITNs) have been shown to reduce the burden of malaria in African villages by providing personal protection and, if coverage of a community is comprehensive, by reducing the infective mosquito population. We do not accept the view that scaling-up this method should be by making villagers pay for nets and insecticide, with subsidies limited so as not to discourage the private sector. We consider that ITNs should be viewed as a public good, like vaccines, and should be provided via the public sector with generous assistance from donors. Our experience is that teams distributing free ITNs, replacing them after about 4 years when they are torn and retreating them annually, have high productivity and provide more comprehensive and equitable coverage than has been reported for marketing systems. Very few of the free nets are misused or sold. The estimated cost would be an annual expenditure of about US$295 million to provide for all of rural tropical Africa where most of the world's malaria exists. This expenditure is affordable by the world community as a whole, but not by its poorest members. Recently, funding of this order of magnitude has been committed by donor agencies for malaria control.

Item Type: Article
Keywords: Africa, Animal, Bedding and Linens/*economics, Female, Human, Insecticides/administration & dosage/*economics, Malaria/*prevention & control, Male, Mosquito Control/methods, Poverty, Public Sector, Rural Population, Africa, Animal, Bedding and Linens, economics, Female, Human, Insecticides, administration & dosage, economics, Malaria, prevention & control, Male, Mosquito Control, methods, Poverty, Public Sector, Rural Population
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
PubMed ID: 12726981
Web of Science ID: 182640600028


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