Malaria disproportionately affects poor, rural populations, with pregnant women and young children at highest risk of severe illness and death. Addressing inequities with actionable strategies, such as the availability of insecticide-treated nets, has been the cornerstone of malaria control efforts for more than a decade.
In April 2008, the Roll Back Malaria Partnership, together with the Secretary-General of the United Nations, launched Cover The Bed Net Gap to achieve universal bed-net coverage by the end of 2010. Since it began, the initiative has resulted in high insecticide treated net coverage through community delivery, routine health services, and other outreach activities.
Before Cover The Bed Net Gap, bed net distribution strategies often focused on populations at higher risk of malaria. Nets frequently went to caregivers of children younger than five during routine vaccinations and to pregnant women during antenatal care visits. In addition, insecticide treated nets were available for purchase either at health facilities or at stores.
As a result, households with higher income were more likely to own insecticide treated nets than the poorest households, probably because of limited access to healthcare. Cover The Bed Net Gap sought to shift distribution from targeted to mass populations to decrease disparities among subgroups. Mass distribution provided one insecticide treated net for every two household members and replaced those nets once every three years.
In 2015, MEASURE Evaluation, with support from the United States Agency for International Development and the President’s Malaria Initiative conducted a multi-country study  to determine the effectiveness of this mass distribution strategy in sub-Saharan Africa. The study used data from Demographic and Health Surveys and Malaria Indicator Surveys to assess the level of equity in bed net ownership before and after the widespread implementation of national ITN distribution.
Yazoumé Yé, a technical director in charge of the malaria portfolio at MEASURE Evaluation, which is funded by USAID, directed the study and co-authored the manuscript with colleagues from the DHS Program. “We’ve made great progress in increasing coverage over the last 10 years,” he says. “Socioeconomic status no longer predicts whether you’ll have access to ITNs. Most countries included in the survey have seen great improvement in equity.”
The study makes a case for future investments in malaria control via national distribution, shown to increase access to ITNs across socioeconomic subgroups. Campaigns providing free insecticide treated nets to mass populations should continue. But that’s not enough, Yazoumé says. “We made the first step in providing free nets, but now we need a process to regularly replace those nets.”
Keeping bed nets in households across the region will require increasing insecticide treated net distribution through various means and ensuring that everybody get protected. “We know mass distribution works,” Yazoumé says. “If we ensure it is funded and being rolled out, we can make great strides toward malaria prevention across sub-Saharan countries.”
For more information on MEASURE Evaluation’s work in malaria, visit https://www.measureevaluation.org/our-work/malaria or read about the effectiveness of insecticide-treated net campaigns at https://www.measureevaluation.org/resources/publications/ja-12-137.