Malaria is still one of the deadliest diseases worldwide. Every year, it results in over 430,000 recorded fatalities, the vast majority of them in sub-Saharan Africa. Although treatment and prevention have improved dramatically, the disease’s transmission persists and takes lives. One of the best tools today is the insecticide-treated net, or ITN. ITNs create a physical barrier between humans and malaria-carrying mosquitoes. As simple as that sounds, ITNs require advocacy and policy efforts, in particular involving governments, to deliver them at scale. In the article that follows, we discuss how governments can play a role and what strategies and policies can improve ITNs.
Understanding Insecticide-Treated Nets
Insecticide-treated nets (ITNs) are designed to serve as a physical barrier to keep vectors such as mosquitoes (the main disease vector) outside a treated environment. ITNs are mosquito nets treated with a synthetic insecticide that functions as mosquito control by killing mosquitoes on contact. IF used consistently and correctly, ITNs are highly effective in reducing the incidence of malaria.
How ITNs Work
- Physical Barrier: ITNs prevent mosquitoes from reaching the person while they sleep, which is when the transmission of malaria is most likely.
- Insecticide Action: The insecticide on the net kills any mosquitoes that come into contact with it, and fewer mosquitoes are now in the area.
- Community Effect: ITNs are up to 75 percent effective at reducing mosquito survival and fecundity. When widely deployed, ITNs can reduce malaria transmission across entire communities, thereby lowering mosquito populations and providing herd protection.
The Role of Governments in ITN Promotion
Governments are important ingredients of effective ITN campaigns. To be effective, governments need to go beyond the simple distribution of ITNs and focus on policy development, funding, education, and monitoring. How exactly should they do that? Here’s a rundown.
1. Policy Development
States need a comprehensive policy for the distribution and use of ITNs. This includes:
- National Malaria Control Policies The Government should integrate ITN distribution into national malaria control programs. ITNs should be included in national health plans, as well as funding priorities.
- Standards and Regulations: There should be regulations on the production and use of ITNs. Governments should impose a scale of standards for ITNs.
2. Funding and Resource Allocation
Financial investment is essential for the successful implementation of ITN programs. Governments can:
- Put Money Where The Mouths Are: Set aside budgetary allocations for malaria prevention and ITNs [installed insecticide-treated nets] to secure the necessary funding to allow for large-scale distribution and maintenance.
- Co-opt International Aid: Most countries align with various international agencies, including the WHO’s Global Alert and Response (GAR) network and the Global Fund, to secure extrabudgetary finance and technical assistance.
3. Distribution Systems
Effective distribution systems are key to reaching those in need. Governments can:
- Coordinate Distribution: Put logistic systems into place to make sure that ITNs reach every remote village, not just the areas most easily accessible, including local health workers and community leaders.
- Combined with Other Programmes: Linking ITN distribution to other health programs such as vaccination campaigns or antenatal care can help to increase coverage and impact.
4. Public Education and Advocacy
Awareness of the benefits and proper use of ITNs within the population is important. Governments should:
- Launch awareness campaigns People already know about the harmful effects of malaria, but more awareness campaigns can bring about more action. For example, public health campaigns can promote ITN use and frequently dispense information about malaria prevention. These campaigns can be highly effective in the culture and are designed to reach people with a variety of features, including foreign language TV, billboards, and cinema.
- Undertake programs to change behavior — try to promote the consistent, correct use of ITNs, for example by addressing misconceptions or resistance in communities.
5. Monitoring and Evaluation
Ongoing monitoring and evaluation can augment efforts to scale up and ensure the effective delivery of ITN programs. Governments can adopt the following:
- Surveillance of Usage and Coverage: Utilising regular surveys and data captures, areas and degrees of ITN usage can be tracked, and gaps in coverage identified.
- Assess impact: monitoring the impact on malaria incidence and overall health over time can have important effects on shaping ITN strategy and allocation of resources.
Case Studies: Successful Government-Led ITN Programs
Tanzania
Tanzania has now rolled back malaria substantially through a nationwide ITN program emphasizing government mechanisms and coordination The Tanzania National Malaria Control Program (NMCP) has embedded ITN distribution into its mainstream malaria prevention strategy with the following features.
- Systematic, National Distribution Campaigns Currently, Tanzania has enacted campaign strategies to deliver ITNs to every home – particularly to those in higher-risk areas.
- Community Engagement: the government partners with local traditional and religious leaders and health workers to promote ITN use and teach communities about malaria prevention.
Ethiopia
Ethiopia’s ITN promotion campaign is noteworthy for the lessons it offers broader public policy and public education, such as:
- Evidence-based interventions: The main intervention recommended by the Ethiopian Government to combat malaria is the distribution of ITNs. The government policies also include detailed plans on how to check quality and ensure coverage. Developed Comprehensive Policies: Ethiopia’s malaria control policies include detailed plans for how to check quality and ensure coverage of interventions. Photo by Tino Maioni/OYE.
- Conducted Mass Media Campaigns: To inform them of the benefits of the ITNs and encourage them to use ITNs, public awareness programs are broadcast via radio, TV, and community meetings across Ethiopia.
Challenges and Opportunities
Despite progress, several challenges remain in promoting ITNs effectively. These include:
- Access and availability: High-quality resources are often unavailable in hard-to-reach and under-served areas. Governments need to enhance distribution networks and think innovatively about solutions, such as mobile clinics.
- Resistance to insecticides: Over time, mosquitoes can develop resistance to insecticides. ITN will need to be continuously researched and adapted.
- Funding Constraints: Funding for ITNs is difficult to acquire, and sometimes difficult to maintain, requiring more creative sources for governments, as well as high-level and sustained commitment to malaria control in national budgets.
Opportunities for Improvement
- Better Coordination: Enhanced collaborations between governments, non-governmental organizations (NGOs), and international organizations improve pooling of resources and programmatic execution.
- Technology innovation: Investment in research and development to improve the technology of ITNs and to develop alternative insecticides that are effective in overcoming resistance.
- Community-Based Approaches: Relying on communities to help plan and carry out the implementation of the ITNs improves the uptake of malaria prevention methods.
The government makes investments to advance the control of malaria by promoting and distributing ITNs. Advocacy and strong policy development, along with adequate funding, efficient distribution systems, public education, and an effective monitoring system, can help to ensure that ITN systems operate at their full potential. Priority tasks include identifying and tackling distribution bottlenecks and enhancing operations where possible. Moving forward, strong and continuing government action and investment can help to ensure that ITNs will continue to be an effective and affordable malaria prevention strategy. Malaria – and malaria deaths – should not be an avoidable scourge of today.
With persistence and cooperation, we can help to make that time come sooner than it otherwise would, with malaria no longer a major cause of suffering or death, and everyone who wants it able to access protection to keep them free from harm.
