The universal coverage campaign for bed nets succeeded in dramatically extending access to these life-saving products, though recent gains may be in jeopardy unless rapid action is taken. Over 560 million long-lasting insecticide-treated nets (LLINs) are required through 2015 alone to achieve and maintain universal coverage in Africa, at a total global cost of $2.4 billion.
A report released today, funded by the Bill & Melinda Gates Foundation and carried out by Results for Development Institute (R4D), identifies strategies necessary to improve the marketplace for LLINs --allowing the global community to improve value for money and hence extend bed net access to hundreds of millions of individuals. The report also argues that market incentives are urgently needed for both improved net performance and innovation to address the mosquito resistance threat. Otherwise, staggering losses in both lives and dollars could occur.
"We cannot allow recent gains in LLIN coverage to make us complacent," said Kanika Bahl, report author and Managing Director at Results for Development Institute. "By modifying their policies, major donors can dramatically reduce global costs and provide incentives for private enterprises to produce better-performing nets."
The report is the first of its kind to look comprehensively at LLIN market dynamics, identifying strategies that, when implemented, will drive savings of up to $630 million for the global community over the next five years. This can provide financing to purchase 150 million additional bed nets, protecting up to 300 million individuals.
The report comes at a time when half the world's population is at alarming risk of malaria. Every day 1,795 people die needlessly from malaria, with annual deaths over 650,000. Meanwhile over 90% of LLINs are donor-funded, with financing precariously concentrated among a small set of major global donors. Aid money has flat-lined as the stability of the global economy remains uncertain.
The study included both an extensive analysis of bed net purchasing data and consultations with over 140 actors across the private and public sector. Private sector consultations included all 10 WHO Pesticide Evaluation Scheme (WHOPES)-recommended LLIN manufacturers. Public sector consultations included five African Ministries of Health in high-malaria burden countries (Nigeria, Kenya, Tanzania, Uganda and Ethiopia) in addition to numerous leading global and in-country institutions.
The report makes six recommendations, proposing specific actions to drive purchasing of the most cost-effective LLINs and generate market incentives for improved net performance including development of new insecticide resistance management products to address the growing threat of mosquito resistance.
A primary recommendation focuses on 'product selection' of the most cost-effective nets. The report shows the benefits of switching from current price-focused policies to ones which value overall cost-effectiveness. Cost-effectiveness policies weight price and performance (chiefly durability, or how long a net lasts). By modifying their policies, donors and countries can save up to $340M while simultaneously creating market incentives for private enterprises to invest in improved net performance and innovation.
The report also argues that 'rationalization' of net specifications (e.g. shape, size, color) is another critical opportunity to drive improved value for money. The current net landscape is highly fragmented, with over 200 manufacturer offerings. Certain specifications generate significantly increased costs for example price premiums of up to 20% for over-sized nets - without evidence of benefits for families using these nets. The report shows that by purchasing the highest value for money net specifications, the global community can save up to $290M while still ensuring a wide choice of over 70 supplier offerings.
Of critical importance, the report also recommends targeted actions to secure future access to insecticide resistance management products. While current LLINs remain effective control tools today, the growing mosquito resistance to current insecticides is concerning. Unless investment are made now to develop insecticide resistance management nets, the global community risks losing ground in recent health gains. The report urges that the global community develop a clear 'path to market' for these products, including appropriate donor and regulatory policies.
"We are seeing troubling trends in the bed net market, including major global funding gaps and mosquito resistance to current net insecticides detected across 27 African countries," said Bahl. "Much more remains to be done to secure vital access to these products."
The report also makes recommendations targeted at strengthening in-country data to support informed net purchasing decisions, employing strategic procurement practices to maintain a competitive supply base, and ensuring a sustainable private sector marketplace to achieve malaria prevention goals.
"We now have the strategies to drive over $600 million in savings, spur innovation, and address the growing threat of resistance. We must act rapidly to prevent losing ground," said Bahl.
The report strategies are now being implemented globally by Results for Development Institute, which is collaborating with global institutions including the Global Fund to Fight AIDS, Tuberculosis and Malaria, President's Malaria Initiative (PMI), the World Health Organization Global Malaria Programme (WHO GMP), African Leaders Malaria Alliance (ALMA), and the Office of the UN Secretary-General's Special Envoy for Malaria to continue promoting LLIN procurement best practices.