We are one of the largest distributors of long-lasting insecticide-treated bed nets in the world: over 297 million bed nets have been delivered by PSI across 38 countries through universal coverage campaigns, through health facilities to pregnant women and infants, and through primary schools.
Long-lasting insecticide-treated bed nets (LLINs) are a powerful tool to reduce malaria transmission at the community level, representing the first line of defense against the disease for an individual. LLINs have played an important role in the remarkable success in reducing malaria burden over the last decade. The World Health Organization recommends that universal coverage – defined as universal access to and use of LLINs – remains the goal for all people at risk of malaria and that this should be achieved through mass, free distributions and continuous distributions through multiple channels in both the public and private sectors.
The main strategy to reach universal LLIN coverage is free, mass distribution. In 2016, we worked with ministries of health from numerous countries to implement mass distribution campaigns or free distribution of LLINs through health facilities and schools. In the past, PSI was also known for socially marketed nets, and some network members continue to sell nets where there is a retail market for them.
Distributing mosquito nets is a major logistical operation as nets are bulky and take up space. A national campaign can require hundreds of shipping containers of nets to be imported, stored and transported across vast distances, on difficult roads and off-road (on boats, on foot, or animal-drawn). A campaign also requires thousands of day workers to be trained and paid for the seven days or so of the distribution. Finally, a campaign calls for a strong social mobilization and communication effort to encourage households to accept the household registration workers, redeem the vouchers at the fixed distribution points, and hang and care for the nets themselves. PSI provides end-to-end support to national governments working on the campaign, and we also often provide just parts of the overall package, working in partnership with other actors contributing their piece of the jigsaw puzzle.
Providing mosquito nets through health facilities and schools poses different challenges. Whereas a mass campaign might happen once every three years, every pregnant woman should receive a net at her first antenatal visit, and every infant at its measles injection usually. This requires health facilities to store nets continuously and to request resupplies as nets are given out. PSI has been providing technical assistance on supply chain management and accountability systems to prevent stock-outs and leakage of free nets into the black market.
Households may require a new net at any time for a variety of reasons: perhaps a relative comes to stay, or a net catches fire on a candle or gets damaged in some other way. PSI empowers people to take control of their own health, and this includes providing people the opportunity to buy a new net if and when they need one. In some countries there is a thriving retail market for LLINs. In other countries it can be hard for families to find a quality-assured insecticide-treated net that they can buy. In those contexts, PSI can facilitate the development of a legal retail market for quality-assured LLINs.
Making a Difference
“I used to stay up all night chasing away mosquitoes,” says Geneviève Ndagijimana, a 34-year-old mother from Burundi. “But it seemed like whatever I did, my children and I would get sick.”
Geneviève and her husband live in the suburbs of Bujumbura with their four children and their two nephews. As far back as they can remember, they all lived in fear of malaria. They had lost too many family members to the disease. “For many years, I suffered from countless cases of malaria, and I lost two children and my brother to the illness. That was a horrible period in my life.”
When she was pregnant with her fifth child, Geneviève was sure she would lose that baby too. So she went to a nearby health center to see if they could help.
“That’s where I met Therese Kaburungu, the health clinic manager,” says Geneviève. “She gave me a mosquito net and told me to take it home and use it. The PSI staff who had given the nets to the health center had said that they were offered by USAID for women just like me.”
That net changed their lives.
“For the first time in years, I slept through the night,” says Geneviève. “When my children and I woke up, none of us had any bites, and since we started using the mosquito net, we have been healthy.”
Geneviève wants other mothers in her community to use a net too. “Now, I always encourage people to use their nets because mosquitoes have no mercy; they kill,” she says. “I have lost family, and I have suffered a lot. But now, my family and I are sleeping safe and sound, and I want others to sleep safely too.”