Public health review : creating an enabling environment for taking insecticide treated nets to national scale; the Tanzanian experience

Abstract

Malaria is the major single cause of health service attendances, hospital admissions and child deaths in Tanzania and a major impediment to social and economic development in the country. Despite the heavy health, social and economic burden efforts to support malaria control have been inadequate. With the advent of Insecticide Treated Nets (ITNs) as a tool for malaria control, the Roll Back Malaria Initiative launched in 1998 advocated renewed emphasis on sustainable preventive measures. Tanzania committed itself at the Summit of African Heads of State in Abuja in April 2000 to protect 60% of its population at high risk by 2005. The country is therefore determined to ensure that sustainable malaria control using ITNs is carried out at national scale. // Tanzania has been involved for two decades in the research process for developing ITNs as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. To this effect, a number of small and large-scale implementation projects have taken place. Since 2000 the emphasis has changed from a project approach to that of a concerted multistakeholder action for taking high coverage of ITNs to national scale. This means creating conditions that make ITNs accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania’s experience in creating an enabling environment for ITN scale-up, and reviews the numerous important issues that need to be considered in making this vision a reality