Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

Abstract

Background: Insecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist.

Methods: To address the gap in continuous distribution cost data, four types of delivery systems-CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)-were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys.

Results: Overall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37-4.61 USD, CD channels: 3.56-9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34-4.55 USD, Ghana and Tanzania 2017 school-based: 3.30-3.69 USD, health facility-based: 3.90-4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions.

Conclusions: These results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.

Keywords: Continuous distribution; Economic cost; Financial cost; Insecticide treated net; Mass campaign; Mass distribution; Universal coverage.

Fig. 1

Unit Financial and economic costs of ITN distribution systems. Unit economic costs are represented in International Dollars (ECC INT$) (Panel 1) and 2016 USD (ECC USD) (Panel 2). Unit financial costs are represented in International Dollars (FINC INT$) (Panel 3) and 2016 USD (FINC USD) (Panel 4)

Fig. 2

Unit financial and economic cost of distribution of ITN distribution systems (full provider perspective and international donor only). Economic Costs in International Dollars (ECC INT$) (Panel 1) and 2016 USD (ECC USD) (Panel 2). Financial costs in 2016 International Dollars (FINC INT$) (Panel 3) and 2016 USD (FINC USD) (Panel 4)

Fig. 3

Line item breakdown of costs in ITN programmes. Economic costs (ECC) (Panel 1) and Financial Costs (FINC) (Panel 2) in 2016 USD