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Malaria Matters: Issue 2, January 1998

Malaria Matters

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By Catherine Reed

Thank you to those of our readers (ten percent) who took the time to return the needs assessment included in our first issue of Malaria Matters featuring Netting News. In doing so, you became eligible for the Net Gain book prize draw. We are pleased to announce that the winners are Dr. T. Adak of India, UNICEF Eritrea, Anup L. Modha of Tanzania, UNICEF Rwanda, and Dr. Ejov Mikhail of Myanmar. Congratulations - your books are on their way!

We received enthusiastic replies from people in several African countries, Europe, North America, India, China, Vietnam, Australia, Japan, and South America, all of whom are working on treated net programmes. Our aim was to gain a greater understanding of the most appropriate mode of communication to reach people. The results so far indicate that all the respondents could be reached by mail, 87% have access to a fax, 76% to e-mail and 55% to the Internet. When broken down into North America, Europe, and the rest of the world (ROW), 64% of respondents from the ROW have access to e-mail and 39% to the Internet as opposed to 100% and 85% respectively for respondents in Europe and North America. When asked, "what is your preferred means of receiving this newsletter?" nearly all respondents from the ROW stated that they prefer the traditional mail system, whereas 61% of the North America/Europe group stated that they prefer e-mail. Only two respondents chose the option of accessing Malaria Matters through the Internet.

There was also a marked difference in the access available to people working in educational institutes and NGOs compared to those who work in health centres/hospitals and government. We anticipate that issues such as access to reliable electronic services, price, and the availability of paper to print messages, will influence these preferences as well.

Results also revealed that the most popular topics for future issues included information about nets, insecticides, new technologies and research findings. Many people were also interested in monitoring and evaluation, case studies, and keeping in touch with meetings and conferences. Though fewer people requested information about training and IEC, many people indicated that they want information about social marketing and "how to sell nets in a poor country". Over time we hope to address many of these issues, and we can do this better if readers are willing to share their experiences with us.

Your comments and suggestions are welcome.

Networking on the Net

By Brijitte Reppen

The World Wide Web has made it possible for a variety of organizations and individuals to publish information electronically for world wide dissemination. As our needs assessment findings indicate, however, the capability to fully access the Internet tends to be more the exception than the rule outside of North America and Europe. The question that remains then, is how can the use of these services be maximized to benefit the most people?

One answer is a new type of server software that has been developed to improve accessibility to the Web for those with e-mail access only. This server is referred to as Web-to-e-mail. With this service, e-mail users can send a message with the address of a specific site to the Web-to-e-mail server; the server will then send the text of the requested web page via e-mail. An example of one of these servers is called "getweb". In order to use the "getweb" service, you must know the addresses (URLs) of the websites you wish to access. For more information on how to use the getweb server, send a message to etweb@unganisha.idrc.ca and write only the word help in the body of the message. Currently there are roughly a half dozen Web-to-e-mail servers operating around the world. If you have Internet access, you can find more information on the Web-to-e-mail server on Bellanet’s website.

Example

From: PATH Canada
To: getweb@unganisha.idrc.ca
Subject: (Do not write anything - leave blank)

Help

In order to use the Web-to-e-mail service effectively you need to be informed about the different websites available. To help with this, Malaria Matters will post relevant addresses. Our goal is only to direct you to useful information about malaria. Therefore, we will provide website addresses in future editions of this newsletter. We welcome your input.

Suggested Web sites

International Development Research Centre (IDRC)

Malaria in Africa - A bilingual publication focused completely on malaria.

Feature: The Turiani Net Project - A Case Study

By Catherine Reed, Henk v.d.Gugten, Paulina Moshi and Desmond Chavasse

The Turiani Bed net project started in 1993 in central Tanzania. The project was run as part of the community-based primary health care activities in the Turiani Hospital. Its objectives were threefold: to make treated mosquito nets available at an acceptable price, to organize a program of 6-monthly retreatments, and to improve the general level of malaria knowledge. The project, to a large extent, has reached these objectives. This is due mainly to the fact that the project monitored its progress over time and made appropriate changes.

Management

The project was very complex at the beginning. There were many different types of nets, multiple activities, and a large staff. By a process of evolution the project has become more focused and streamlined and thus more efficient.

Staffing has been an ongoing challenge. While the project has been supported by hospital administration, it has not been fully integrated into the hospital’s day-to-day activities. Consequently, time spent on the project by staff is above and beyond their regular duties. This lack of integration has made it necessary to have a separate accounting system, which at times has led to difficulties.

Nets

In 1993 there were several types of nets available, some locally made and some ready-made. Presently, there are only two options - small and large square nets - all imported and ready-made. This change will reduce local labour charges by 300 Tsh per net which should make them cheaper, and should simplify logistics because there is no need for supervising the manufacturing of nets locally. Originally it was hoped that more local people might be involved in making nets and thereby benefiting financially from the project, but in reality the whole process was usually done by one tailor and his extended family.

When the project started in 1993, the staff developed a revolving fund with a $9,000 (US) donation from Memissa. In 1997, the project was successfully maintaining a financial balance of just under $9,000 and nearly 6,000 nets have been sold.

In 1993, nets cost 1,500- 2,200 Tsh, which was slightly below the market price of 2,500-3,000 Tsh. Over the years, prices have increased in line with costs. At present a net costs 3,500 Tsh (about $7US), which includes the price of the net, customs, duty, transport, wages and the first insecticide treatment. These cost factors make it very important for the project to obtain raw materials as cheaply as possible. Ordering materials locally from Tanzania has been unsucessful because either the material is not ready when needed, or the price is greater than imported materials.

Insecticide

Previously, the practice of treating nets with insecticide was done in mass quantities. This process was stopped because of rumors that the nets were not really being treated prior to sale and because individuals complained about having their old net retreated in the same dirty solution as their neighbours. As a result, all new nets are treated individually, in the presence of the customer, with permethrin (500 mg/m2). Even though retreatment costs are low (200Tsh), no one wants to pay for it. The actual cost (400-500Tsh) to treat a net is subsidised by the project from the net sales. Because people seem more willing to buy new nets than old retreated ones, project staff are considering including the cost of one retreatment in the initial price of the net. These decisions are based on evidence that people view nets and insecticide as very different commodities. People will travel miles to a central location to purchase their nets, yet they expect insecticide treatments to be available locally, with- in the community. At this time, it is uncertain what can be done to improve sales of insecticide. There is a real need to carefully examine the poor retreatment rates, and to review promotional strategies. Unfortunately, there is little time or funds available to do either.

Coverage

Prior to the project, approximately 20% of households owned one or more nets. During the first year of the project, results from a survey on net purchasers suggested that 60% of nets purchased were sold to families who already owned them. While there has been increased coverage of people within households who own nets, it is not known whether the cheaper, more readily available nets have increased the total number of households which own nets. To accurately assess net ownership within a community and coverage within the household requires a further survey. Again, time and funds are limited.

Lessons learned

One of the overriding lessons apparent in the Turiani project, is its change and adaptation over time, which has been the result of careful monitoring and evaluation. Throughout this process, it has become clear that extra attention needs to be given to the problem of poor retreatment rates and actual coverage of treated nets.

For more information, please contact us or Turiani Hospital, Private Bag, Morogoro, Tanzania.

In the Field

Do It Yourself Net Kits: A New Concept

By Marcel Dubbelman

Many projects presently manufacture mosquito nets on a small scale, employing local people who purchase rolls of netting which they cut and sew themselves. Due to inexperience, this can sometimes result in wasted material and inefficient use of time. As a result, one manufacturer has developed the Do-It-Yourself (D.I.Y.) net kit. The kit consists of a plastic bag containing pre-cut panels, a washing tag (a printed cloth label giving net retreatment instructions to be sewn to the net), and four ‘eyes’ for suspension.

According to the manufacturer the D.I.Y. kit offers 3 major advantages. First, the cutting of netting can be quite difficult, and in the D.I.Y. kit the netting is professionally pre-cut into standard sizes, which lessens the chance of error and eliminates waste.

Second, the ready-made nets are press-baled prior to shipment which reduces the volume of the product and reduces freight costs. It is more difficult to compress rolls of netting due to their width and volume. In fact, once net kits are packed and compressed, a container can hold up to 50% more kits when compared to netting rolls.

Finally, the manufacturer believes that it is easier to monitor the distribution of nets through kits. It is not always clear how many nets will be produced with an uncut roll but with the use of kits the number of uncut nets provided is also the number of finished bed nets. This in turn would improve accountability, and ease problems of storage and cutting space.

For more information, please contact:

Marcel Dubbelman, Siamdutch Mosquito Netting Co. Bangkok - Thailand
Fax: 66 2 259 50 84
Email: siamdutch@loxinfo.co.th

A New Approach to the Supply Problem in Papua New Guinea (PNG)

By Desmond Chavasse

In 1996, a committee composed of representatives from the World Health Organization, Rotary and PNG Department of Health launched a new project called Rotary Against Malaria (RAM) - PNG. Donor funding was provided by the Australian government. RAM organized the procurement of supplies of nets and insecticides which are stored in one of the Rotary members facilities. These supplies are available to any organization in PNG to purchase in bulk for local distribution. RAM have been running an advertising campaign to encourage organizations to buy their supplies. Such organizations include the provincial health departments, industrial companies who wish to protect their employees, NGOs, schools and church groups. The beauty of the RAM system is that a small organization can have access to a national supplier of cheap nets and insecticides. RAM, themselves, are not involved in wide scale distribution, they are simply making supplies available at the lowest possible sustainable cost, ie replacement cost. In this way, irrespective of the success or failure of the distributing organization, a stock of supplies is maintained for new distributing initiatives.

Rotary members have particular resources and attributes which make them valuable collaborators in the operationalization of nets. These resources include:

Sound business sense. Most Rotary members are successful members of the business community. An understanding of business is essential for implementing nets through the private sector, which is inevitable for countries without a highly efficient and vertical malaria control program.
Specific and relevant expertise. Members who have expertise in areas such as advertising, procurement and import are potentially valuable partners.
Access to logistic and manpower resources. Through their work, Rotary members may be able to contribute resources at particular times including such things as labour, storage, and transport.

Rotary offers a unique resource with which to collaborate. A local club can determine how best to use its strengths in terms of human skills, technical backup and logistical resources to facilitate the implementation of local treated net schemes. The example from PNG shows just one way in which a local organization can have a nation-wide impact on implementation.