The National Malaria Control Programme in the Tanzanian Ministry of Health and Social Welfare (MoHSW) has been spearheading the National Insecticide Treated Nets (NATNETS) Programme since 2000 to plan, implement and manage the scaling-up of Insecticide Treated Net (ITN) use in Tanzania.
NATNETS is a multi-donor and multi-partner initiative that has been very successful in developing and implementing a combination of ‘Catch Up’ (Mass Campaign) and well as ‘Keep Up’ (Continuous Distribution) Strategies.
What are ITNs and LLINs?
An insecticide-treated net is a mosquito net that repels, disables and/or kills mosquitoes coming into contact with insecticide on the netting material. There are two categories of ITNs:
- A conventionally treated net (ITN): a mosquito net that has been treated by dipping in a WHO-recommended insecticide. To ensure its continued effect, the net should be re-treated after three washes, or at least once a year.
- A long-lasting insecticide treated net (LLIN): a factory-treated mosquito net made with netting material that has insecticide incorporated within or bound around the fibres, which remains for at least three years of recommended use under field conditions.
All mosquito nets act as a physical barrier between the individual(s) using the nets and the vector (mosquito).
The pyrethroid insecticides on the treated nets have a repellent effect that adds a chemical barrier to the physical one. The insecticide kills the malaria vectors that come into contact with the ITN.
By reducing the vector population in this way, ITNs, when used by a majority of the target population, provide protection for all people in the community, including those who do not themselves sleep under nets. Studies have shown that relatively modest coverage (around 60%) of all adults and children can achieve equitable community-wide benefits. ITNs have been shown to avert around 50% of malaria cases.
Objectives and Components of NATNETS
The objective of the NATNETS strategy is to: Maintain universal access of the population to Long-Lasting Insecticide Treated Nets (LLINs) so that the households with at least one LLIN for every two persons will increase from 74% (2012) to 85% (2020)
NATNETS consist of five key components:
The ITN Cell: A cell within the Vector Control Unit of the National Malaria Control Programme which coordinates and facilitates all NATNETS activities. It is supported by the Swiss Agency for Development and Cooperation (SDC) through the NETCELL Project which is managed by the Swiss Tropical and Public Health Institute (Swiss TPH) since 2003.
The Tanzania National Voucher Scheme (TNVS): Also known as Hati Punguzo in Kiswahili, an ongoing programme that was established in 2004 to provide pregnant women and infants with a Long Lasting Insecticidal Nets (LLINs) at greatly reduced price (Tsh 500 for a LLIN, equivalent to $0.30). Funding has been provided by different donors over the years, including the Global Fund to Fight AIDS, TB and Malaria (GFATM), United States Agency for Aid and Development (USAID), and currently the UK Department for International Development (DFID).
The School Net Programme (SNP): A school-based LLIN distribution funded by SDC and USAID that provides every school child in alternate classes a free LLIN for distribution to their households. The programme was piloted in 19 districts of the Southern Zone (Lindi, Mtwara and Ruvuma Regions) in 2013 and the second round will be completed in August 2014. The intention is that the programme is repeated annually so that a child will bring home a new net to his or her household every two years. The MoHSW will decide after the second round whether the SNP will be launcher as the national LLIN keep up strategy.
LLIN Mass Distribution Campaigns: Two mass campaigns have been implemented since 2009 and a third one is being planned.
- An Under Five Catch-up Campaign (U5CC) from April 2009 to May 2010 which provided 8.7 million Long Lasting Insecticide Treated Nets (LLINs) to all children under the age of five;
- Universal Coverage Campaign (UCC) from October 2010 until October 2011 which provided 17.6 million LLINs for all sleeping spaces that had not been covered during the U5CC or the Tanzania National Voucher Scheme.
- A Mass LLIN Replacement Campaign expected to be rolled out mid-2015 which will provide 22 million nets to all households in Tanzania, with the exception of the Southern Zone where the SNP is being implemented.
Behaviour Change Communication (BCC): A series of complementary interventions to create and sustain a culture of net use, implemented by several international partners including Population Services International (http://www.psi.org/tanzania), and the Johns Hopkins Centre for Communication Programmes (http://www.jhuccp.org/whatwedo/projects/communication-and-malaria-initiative-tanzania-commit) who work closely with a network of Tanzanian NGOs, and civil society organisations.the climatic and geographic suitability in most of the country, even where prevalence has declined due to control efforts. Continued and sustained investments in malaria control remain vital.