Africa: Making Every Net Count - Evidence, Delivery and Impact At Scale

Insecticide-treated nets (ITNs) are a highly effective tool for preventing malaria, but making the most of these nets in Nigeria requires addressing several challenges. Malaria remains a significant health concern in the country, and ensuring that every net is used correctly and consistently is crucial to maximizing its impact. Malaria Consortium, in collaboration with Nigeria's National Malaria Elimination Programme and State Malaria Elimination Programmes, is undertaking a massive ITN distribution effort across four states, with support from a $62 million grant from Open Philanthropy.

The distribution process is designed to reach every household, with community health workers registering each household and tracking the distribution through a digital platform. This data-driven approach allows the program to identify and address implementation issues in real-time, such as bottlenecks or areas that are underserved.

However, the effectiveness of ITNs can be compromised by mosquito resistance to the insecticides used in the nets. To counter this, newer dual-active ingredient nets are being distributed, which provide superior protection against malaria transmission. The campaign must carefully select the appropriate net type based on local mosquito resistance levels to ensure optimal protection.

The success of the campaign hinges on proper net use and durability. Nets must be correctly used and remain intact and effective for their intended duration. Gathering evidence on these factors is essential for evaluating the campaign's impact and informing future efforts. Malaria Consortium is working closely with existing state and community structures to support government-led implementation and promote the long-term sustainability of malaria prevention efforts.

A key aspect of the campaign involves engaging with community leaders, religious institutions, women's groups, and other stakeholders to raise awareness, encourage participation, and address practical barriers, misconceptions, and the misuse of ITNs. The goal is to foster a sense of ownership among communities in eliminating malaria. The distribution includes multiple rounds of household surveys to monitor net access, use, retention, attrition, physical durability, and the factors influencing net maintenance and longevity.

To understand the barriers to consistent net use, Malaria Consortium partnered with the Behavioural Insights Team on the Be In A Net project. This project explored practical and behavioral obstacles to net use in Nigeria and Uganda, testing whether low-cost, locally informed approaches could help overcome them. The research involved reviewing previous studies, gathering insights from residents in homes and through household observations, interviews, and focus groups.

Based on this evidence, the project developed two interventions: providing soft, colored nets by default and implementing a Net Champion program that rewards sustained net use. These low-cost interventions show promise in enhancing the effectiveness of net use.