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Malawi

Real lives

Social marketing enables widespread mosquito net usage in Malawi

In a small district hospital of Kasungu, central Malawi, Kate is wrapping her three-day-old son in a yellow blanket. She smiles at her baby, oblivious to her environment. She doesn’t notice the green mosquito net that hangs above her bed, like a colourful detail in the white room. This detail could save her son’s life.

Malaria kills an African child every 30 seconds. A simple US$3 mosquito net could protect them from this deadly disease. Additionally, providing pregnant women with anti-malaria tablets twice during their pregnancy greatly reduces their risk of infection and of having low-birth weight babies, a major cause of infant death.

“I have had malaria and everybody I know has had malaria,” says Kate. “During my pregnancy I came several times to the hospital for ante-natal check ups and the staff told me about mosquito nets. I will buy a net from the hospital when I go home. I want to protect my baby.” She also received an anti-malarial drug during the fourth and seventh months of her pregnancy.

Kate is one of the 2,500 women who delivered their infant at the Kasungu hospital in 2002 and bought a mosquito net for 50 kwacha (less than 20 US cents). The price of the mosquito net, which is sold with an insecticide treatment kit, is heavily subsidized by UNICEF in the rural hospitals and health care centres of Malawi, one of the poorest countries in the world. During the rainy season, when the risk of malaria is the highest, the Kasungu Hospital sells up to 450 nets a day.

UNICEF, in collaboration with national and international partners, supports anti-malaria programmes focusing on children under the age of five and pregnant women in all sub-Saharan countries. In 2002 alone, UNICEF provided over 4.4 million mosquito nets to 25 African countries, for a total value of $9.5 million, making it the largest mosquito net buyer in the world. This represents a 175 per cent increase since 2001. In addition, UNICEF purchased $3 million worth of insecticide, used to treat the mosquito nets.

Malawi's anti-malaria programme is three-fold:

  • Pregnant women and children under five in rural areas can buy nets and insecticide for 50 kwacha (20 US cents). Pregnant women are also given anti-malaria tablets during their pregnancy and can buy the re-treatment kit (which includes an insecticide tablet, plastic gloves and a measuring plastic bag) for 20 kwacha (8 US cents).
  • Other rural families can buy the same nets for 100 kwacha (40 US cents) through their village health committees.
  • Urban families, which are better off, can buy the nets and insecticide at the commercial rate of 395 kwacha (US $4).
    Nets are not given for free, even to the poorest families, to ensure that they consider the net a valuable item. Communities themselves were consulted on the cost of the mosquito nets and agreed on the price of 50 kwacha. However small, this money contributes to the recovery of cost.

Nurses who sell nets receive a small incentive. Village health committees who sell mosquito nets receive 20 per cent of the price and can use this money for health-related activities in the village. In a village near Kasungu, the community was able to provide electricity to the local health facility. Another village drilled three wells to provide drinking water. In some cases, the Village Health Committee will receive a chicken or some maize flour in exchange for a net.

“We bought 120 mosquito nets in November 2001. We sold all of them and tomorrow I’ll buy another 70 nets,” says the chairman of the Kanin’ga village health committee in Kasungu district. “People have already paid for them. Some of our committee members were trained on the use and treatment of nets with insecticide, so that they can inform families who buy them.”

Both at the hospital and at the village level, women who buy mosquito nets receive information about the proper use of the net and its re-treatment. This information supplements the simple colourful leaflet that accompanies the net and the treatment kit.
In urban centres, mosquito nets are available in many shops. It is not rare to spot a net between a pile of eggs and soft drinks. The nets are blue and conical, and the packaging is more sophisticated and also contains the same re-treatment kit. Signs promoting the use of mosquito nets dangle outside the shops.

The commercial sale of mosquito nets became national in November 2002, and over 136,000 nets were sold in just one month “Since the actual cost of an insecticide-treated net is about US$3, commercial nets are sold with a profit. This profit helps covering the cost of subsidized nets. It’s important for the sustainability of the programme”, explains Dr. Desmond Chavasse, the Director of Population Services International (PSI) in Malawi.

This strategy, called social marketing, is being used in many countries to increase the use of mosquito nets and other health-related items. It focuses on the urban middle and upper class families who can afford to buy a mosquito net at a commercial price. “This way, we ensure that our limited resources are used for the poorest and most vulnerable populations: pregnant women and children under five in rural villages,” says Dr. Chavasse.


 

 

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