How Many Bed Nets Does it Take to Contain Malaria?

How many bed nets does it take to contain malaria?

By Naomi Printz, Malaria Taskforce Technical Adviser, USAID | DELIVER PROJECT, JSI.

For their recent universal coverage campaign, Nigeria procured and distributed 46.9 million bed nets; stretched end-to-end, they would encircle the earth 3.9 times.

That is a lot of nets. And this statistic represents just one campaign in one country. The demand for long-lasting insecticide-treated bed nets (LLINs) is rising each year as more countries increase their efforts to reduce their malaria burden through the support of country governments, the President’s Malaria Initiative (PMI), the Global Fund, and other partners. The graph below shows the total value of commodities procured by the USAID | DELIVER PROJECT (the project) by commodity type, by financial year.

The task of procuring and delivering enough bed nets to meet the needs of 25 countries under PMI requires a coordinated global effort of public health logisticians, malaria experts, evaluation specialists, and more.
Yet, it is not enough to simply procure and ship bed nets—or medicines, tests, and laboratory supplies, for that matter—to health facilities around the globe. As the Nigeria universal access campaign shows, each country requires a customized solution.

The USAID | DELIVER PROJECT works with each of the 25 countries it supports under PMI to carefully tailor the management of their malaria supply chains.

For example:   

• Nigeria: In November 2009, Nigeria launched an ambitious campaign to provide universal bed net coverage. The goal of the campaign was to ensure that every sleeping space in each household was covered by a net, which equals one net for every two people per household. The project played an important role in the supply chain management and distribution of the 46.9 million nets, utilizing large freight trucks, pickup trucks, boats, and bicycles to transport the nets to target households.

• Southeast Asia: In many countries, nets are hung over the sleeping space. However, in countries like Cambodia, Laos, and Burma, where hammocks are used for sleeping, the standard bed net was not appropriate. The project worked with these countries to procure hammock nets instead.

• Madagascar:
  To better track proof of delivery down the supply chain from central warehouses to households, the project turned to mobile phones. A basic SMS confirmation system is used to confirm delivery and receipt of specific quantities of malaria commodities.

• Ghana:  Concern arose over the proper disposal of the bags in which malaria nets are delivered, since the bags come in contact with chemicals and are considered hazardous waste. The project helped identify vendors in Ghana who could either incinerate the bags according to the environmental standards of the Ghana Environmental Protection Agency and the U.S. Agency for International Development or safely recycle the bags and convert them into paving stones.

As the project works with countries to effectively manage their malaria supply chains, the demand for nets, meds, and tests is likely to grow. Keeping up with this growing demand will present new challenges, such as increasing lead times from order to delivery and improving data visibility. However, the country examples above demonstrate that collaboration among all stakeholders—from global funders down to the man or woman on the bicycle delivering supplies—is already having  a tremendous impact.

So, how many bed nets does it take to control malaria?

Oh, just a few hundred million… delivered to the right place, at the right time, in the right quantities, and for the right cost.

John Snow, Inc., and our nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities throughout the world.For more than 30 years, Boston-based JSI and our affiliates have provided high-quality technical and managerial assistance to public health programs worldwide. JSI has implemented projects in 106 countries, and currently operates from eight U.S. and 81 international offices, with more than 500 U.S.-based professionals and 1,600 host country staff.

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