Insecticide-treated bed nets—a crucial part of malaria protection throughout sub-Saharan Africa and regions of Asia—have long been distributed to people who need them through mass campaigns conducted every three years.

A health economist from Tulane University modeled different options, with cost and operational considerations in mind. What they came up with was a plan to distribute nets annually to children in schools to supplement the regular distribution of nets to pregnant women and infants at health facilities instead of mass campaigns.

According to recently released results from the 2017 Tanzania Malaria Indicator Survey, more than 70% of people in those regions had an insecticide-treated net to sleep under in 2017, a rate that has been maintained steadily since the program began.

"The idea of replacing mass campaigns with yearly school net distributions was pretty revolutionary, frankly. It hadn't ever been tried on such a large scale," she says. "What we found in Tanzania is that school-based net distribution has proven to be an innovation that streamlines the net delivery process and makes nets accessible to more people in a cost-effective way. You need careful planning to make the switchover to school distribution but Tanzania shows that it can work."

School-based program

As the school-based program has matured, the distribution of nets has been integrated with a government education database that collects enrollment figures, simplifying the process and ensuring more accurate counts of students and of nets delivered. 

Following the success in the south, Tanzania scaled up school distribution to 11 other high-burden regions in 2016. The program is now in its third year distributing nets in schools in 14 regions of the country, supplementing distribution channels that have long been in place at health facilities where prenatal care and vaccinations are provided. With PMI funding, VectorWorks has also assisted with similar school programs in Ghana, Guinea, and Mozambique.

Insecticide-treated bed nets

Insecticide-treated bed nets are a critically important malaria control tool. An estimated 663 million cases of malaria have been averted in sub-Saharan Africa since 2001. The World Health Organization says an estimated 69% of that decline was due to the availability and use of insecticide-treated mosquito nets.

In the school-based system, nets are usually distributed to half the classes, which allows a household's children to receive nets at primary school every other year. One of the keys to success there, Koenker says, is that the schools and the government coordinate to ensure accurate student enrollment counts—and subsequent delivery of the right number of nets.

In Tanzania where the new system has been implemented, between the nets given to pregnant women and infants at health clinics and school-based distribution, nets reach two-thirds of households. But those households encompass 85% of the population.

"You may be missing some families that don't have school-aged children, but that doesn't appear to be affecting the overall access to nets," she says. "We are seeing better results with school-based distribution. It's really working."