The question of whether to donate insecticide-treated mosquito nets to prevent the spread of malaria or to charge a fee for them as is the common practice in many social marketing programs in Africa has been a raging question over the past year and more. Jeffrey Sachs, the UN Secretary-General's special adviser on the Millenium Development Goals, has argued that the $3 nets should be heavily subsidized or given away free. "Mothers and children are dying of a completely preventable disease because we are trying to sell bed nets. Let me urge the end of social marketing today." Now comes some empirical evidence that provides evidence for both sides of the debate.
METHODS: Over several years questionnaires and surveys of usage and condition of nets were carried out throughout a town and 15 villages in north-east Tanzania, where nets and insecticide have to be purchased and in 24 other villages where over 15000 nets had been donated and annual re-treatment is provided free-of-charge.
RESULTS: There was very high population coverage in the town but, in the villages where nets have to be purchased, only 9.3% of people used nets which were intact and/or had been insecticide-treated and could, therefore, provide protection. However, where nets had been provided free, over 90% of the nets were still present and were brought for re-treatment several years later.
CONCLUSIONS: In this part of Tanzania, social marketing has performed well in a town but very poorly in villages. However, the study showed that people look after and bring for re-treatment nets which had been provided free-of-charge. [Abstract] [Free access to pdf version of the manuscript at Malaria Journal]