Abstract
BackgroundThe cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.MethodsEconomic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted.Results and ConclusionThe total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.
Highlights
The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established
We have attempted to capture as fully as possible all costs associated with running a national scale ITN distribution programme, including all training and logistical activities
This analysis differs from many others in that it captures the full costs incurred including time and travel costs of users to collect the nets as well as the top up prices charged by retailers
Summary
The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. The statement argues that separating the delivery of a targeted subsidy and the ITNs through distribution of vouchers or coupons to a target population makes it possible to stimulate local trade by building and maintaining a countrywide network of outlets. In this way "commercial demand and the commercial market are strengthened while the burden on the public health system of the logistics and distribution of ITNs, including long lasting nets, and of the associated management functions, is reduced" [8]. The WHO statement recognizes that a decision to use vouchers should be considered in light of local experience
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