Vouching for bednets
Senegal beats back malaria with a deadly featherweight

Admiral R. Timothy Ziemer, the U.S. Malaria Coordinator, (right) and Dr. Toumani Toure, the Chief Doctor of the Khombole District (center), meet young Senegalese mother Ami Dioume, who redeemed a USAID-sponsored voucher in Khombole that enabled her to buy a net and protect her children from mosquitoes. Photo: R. Nyberg, USAID

The people of Khombole know that mosquito nets are good for them.  Not only do they protect against malaria, but they also fend off buzzing, biting, belligerent mosquitoes that thwart a peaceful night’s rest.

Most people also know that pregnant women and young children are the most vulnerable to malaria.  For them, the disease is the most dangerous and life-threatening.

Many families in Senegal can afford a treated mosquito net at the local market price – about $7 for the cheapest treated net – but many more cannot.  When the nets are available at local government health clinics, the Government of Senegal sells them for $2 each, but the supply is unreliable, they run out of stock frequently, and clients rarely have a choice about the type of net they get.  But in Khombole and five other districts in Senegal, a different system is covering greater ground.

USAID’s NetMark project brings together the companies who manufacture and distribute insecticide-treated bednets (ITNs) and the local health committee at each facility.  The health committees then decide which brands, types, and sizes of nets they would like to offer at their facilities, and negotiate with the companies for suitable prices.

NetMark provides books of vouchers and training so that when pregnant women or young children come in for services at the facility, the health workers talk to them about ITNs and ensure that they already use one; if not, they get a voucher.  The voucher is a personalized $5 coupon the family can redeem toward the purchase of an ITN at the health facility’s pharmacy. That’s what Ami Dioume did.

“This is the first net in our family,” said the pregnant Senegalese mother of four who just redeemed her voucher and paid a $2 contribution for her net at the Khombole health center.  “I just had my two-year-old daughter treated for malaria here, and I learned about the net. I want it now to protect my family,” she added, as U.S. Malaria Coordinator, Admiral R. Timothy Ziemer, looked on.

The ITN companies make periodic visits to the facilities, collect the redeemed vouchers, and restock the nets.  USAID’s NetMark project reimburses them for the exchanged vouchers.  This way, everyone benefits: health committees make a small profit from what is sold at their facility, and have an incentive to ensure that women redeem their vouchers and use the nets.  The private sector sells its nets and ensures a constant supply of stock at all participating facilities.  Because the vouchers are personalized and marked for use only for pregnant women and young children, USAID’s support effectively targets the most vulnerable groups.  Health workers and facilities offer an improved service to their clients.  And ultimately, vulnerable groups are better shielded from malaria.

In the 20 clinics participating at the end of 2006, almost 90% of women who were issued vouchers redeemed them, adding their minimal contribution to get their nets.  These 22,302 mosquito nets went to families who, thanks to voucher records, can be followed-up in local health committee outreach efforts to make sure the nets are being used correctly.