Social Marketing of Bednets in Tanzania

Published in the World Bank Institute's Development Outreach, this document explores the use of social marketing to increase access to insecticide-treated nets (ITNs) by those most vulnerable to malaria. According to UNICEF (2003), malaria kills at least one million people every year in sub-Saharan Africa, with more than 3,000 children dying of the disease every day. This document explores social marketing as an effective strategy - especially when used in conjunction with community participation - to sell ITNs in order to reduce malaria morbidity and mortality.

Specifically, the authors examine the Tanzanian social marketing programme known as KINET, implemented by Ifakara Health Research and Development Centre (IHRDC) and Population Services International (PSI) in 2 rural districts, Kilombero and Ulanga. KINET is characterised here as a "pro-poor initiative" in that it involved a discount system and annual household coverage surveys in an effort to deliver the ITNs to young children and pregnant women described as "the poorest".

The authors note that, throughout the 5 phases of the initiative, community members were given a primary role. First, the research team in partnership with district health management team held sensitisation meetings with village leaders. Community preference studies were conducted to identify preferences for size, quality, and colour of the ITNs to be produced. Following a demographic surveillance system (DSS), formative research was conducted to explore community perceptions of severe childhood disease. Results of this research were used to develop promotional materials including billboards posted along main roads, posters, leaflets, exercise books used at primary schools, tee-shirts, umbrellas, caps, and point-of-sale stickers and flags.

Community participation was also central to the distribution system, which involved information education and communication (IEC) seminars held every 6 months for the sales agents (chosen jointly by project staff and community members), as well as for groups of specially recruited village resource people (village leaders, village health workers, primary school teachers and maternal and child health (MCH) aides). A reward system was set up for the retailers, who initially delivered the ITNs on bicycles, enabling the offering door-to-door services to those even in remote, rural areas.

The authors note that partnership was also a key component of this social marketing programme in that it relied on collaboration with public entities such as the district health management team and Ministry of Health, the private sector such as international and local suppliers, local businesspeople, and non-governmental organisations (NGOs) involved in health.

These strategies were found to be successful. By the end of the third year, a population of about 500,000 in 112 villages had been covered. The coverage, measured by percent of households with at least one ITN, improved from 37% in 1997 to 73% at the end of 2000. Coverage among the households categorised as economically poorest improved from 20% to 54%.