Effectiveness and equity of the Tanzania National Voucher Scheme for mosquito nets over 10 years of implementation

• Published in: Malaria Journal
• Main Authors: Karen Kramer, Renata Mandike, Rose Nathan, Ally Mohamed, Matthew Lynch, Nick Brown, Ally Mnzava, Wilhelmina Rimisho, Christian Lengeler
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2017
• Subjects: Public private partnership; Malaria; Vector control; Insecticide-treated nets; Long-lasting insecticidal nets; Keep up strategy; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-017-1902-0; https://doaj.org/article/82efaa05ff134294b1464314ff7c3e3f

Abstract Background The Tanzania National Voucher Scheme (TNVS) was a public private partnership managed by the Ministry of Health that provided pregnant women and infants with highly subsidized (long-lasting) insecticide-treated nets between 2004 and 2014. It was implemented in the context of the National Insecticide Treated Nets (NATNETS) Programme and was the main keep up strategy for vulnerable populations. Case description The programme design was adjusted considerably over time to incorporate new evidence, shifting public health policies, and changing donor priorities. Three TNVS models can be distinguished: (1) the fixed discount; (2) the fixed top-up; (3) the hybrid voucher model. The changes improved equity and effectiveness, but also had a profound effect on how the programme was managed and implemented. Results The TNVS reached the majority of beneficiaries with vouchers, and significantly increased household ownership and use of LLINs. While two mass distribution campaigns implemented between 2009 and 2011 achieved universal coverage and equity, the TNVS ensured continuous protection of the vulnerable populations before, during and after the campaigns. The TNVS stimulated and maintained a large national retail network which managed the LLIN supply chain. Discussion and lessons learned The effectiveness of the TNVS was a function of several interdependent factors, including the supply chain of vouchers through the public health system; the supply chain of nets in the commercial sector; the demand for nets from voucher recipients; management and risk mitigation measures; and the influence of global and donor objectives. Conclusion The TNVS was a highly innovative and globally influential programme, which stimulated the thinking around effectively and equitably distributing ITNs, and contributed directly to the evolution of global policy. It was a fundamental component of the NATNETS programme which protected a malaria-vulnerable population for over a decade.