The economics of social marketing: the case of mosquito nets in Tanzania.

There is a growing appreciation of the role of the private sector in expanding the use of key health interventions. At the policy level, this has raised questions about how public sector resources can best be used to encourage the private sector in order to achieve public health impact. Social marketing has increasingly been used to distribute public health products in developing countries. The Kilombero and Ulanga Insecticide-Treated Net Project (KINET) project used a social marketing approach in two districts of Tanzania to stimulate the development of the market for insecticide-treated mosquito nets (ITNs) for malaria control. Using evidence from household surveys, focus group discussions and a costing study in the intervention area and a control area, this paper examines two issues: (1) How does social marketing affect the market for ITNs, where this is described in terms of price and coverage levels; and (2) What does the added cost of social marketing "buy" in terms of coverage and equity, compared with an unassisted commercial sector model? It appears that supply improved in both areas, although there was a greater increase in supply in the intervention area. However, the main impact of social marketing on the market for nets was to shift demand in the intervention district, leading to a higher coverage market outcome. While social marketing was more costly per net distributed than the unassisted commercial sector, higher overall levels of coverage were achieved in the social marketing area together with higher coverage of the lowest socioeconomic group, of pregnant women and children under 5 years, and of those living on the periphery of their villages. These findings are interpreted in the context of Tanzania's national plan for scaling up ITNs

L’expansion due soin du post avortement compréhensif vers les établissements de la santé primaire dans le district de Geita, Tanzanie

A postabortion care program was implemented in 11 primary and secondary health facilities in rural Tanzania in order to decentralize comprehensive postabortion care to community level by upgrading midlevel providers to perform manual vacuum aspiration (MVA). Information about evacuation procedure and family planning (FP) service provided was obtained from the health facilities. In all, 2025 evacuations had been performed with MVA and D&C accounting for 65.6% and 34.4%, respectively. Among the women admitted with abortion complications, 59.8% left with a FP method. The proportion of women offered FP service differed by evacuation procedure, hence the proportion was higher among women evacuated by MVA. Upgrading midlevel providers to perform MVA is an efficient means to address the problem of unsafe abortion in rural areas. However, the sustainability of MVA service provision remains a challenge. Moreover, FP services should be offered to all postabortion clients regardless of evacuation procedure (Afr J Reprod Health 2009; 13[2]:129-138).Un programme du soin du post-avortement a été mis en oeuvre dans des établissements de la santé primaire et secondaire dans la Tanzanie rurale afin de décentraliser le soin du post-avortement compréhensif jusqu’au niveau de la communauté par l’augmentation de la performance des dispensateurs moyens pour qu’ils puisement faire l’avortement par aspiration manuelle (AAM). Le renseignement sur la procédure de l’évacuation et sur le service la planification familiale (PF) disponible était obtenu à partir des établissements de santé. En tout, 2025 évacuations ont été faits à travers AAM et le curetage de l’utérus étant responsable pour 65,6% et 34,4% respectivement. Parmi les femmes qui ont été admises avec des complications de l’avortement, 59,8% sont parties avec une méthode de la PF. La proportion des femmes qui ont profité des services de la PF était différente par la procédure de l’évacuation ; ainsi, la proportion était plus élevé chez les femmes qui ont subi l’évacuation par l’AAM. L’amélioration de la performance des dispensateurs moyens pour accomplir l’AAM est une manière efficace de s’occuper du problème de l’avortement dangereux dans les régions rurales. Toutefois, la capacité pour soutenir la dispensation des services de l’AAM reste un défi. De plus, les services de la PF doivent être offerts à toutes les clients du post-avortement sans considérer la procédure d’évacuation (Afr J Reprod Health 2009; 13[2] :129-138)

Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

OBJECTIVE: To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. METHODS: Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. FINDINGS: The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. CONCLUSION: The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria