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Submitted by Rob Yates on

In learning from Kenya's tremendous success in scaling up bed net coverage this lesson from your excellent blog is extremely important:

"The nets that had just been distributed to them free of cost would make a huge difference, they said, protecting them from being bitten by mosquitos, and saving them considerable expense. Many of the families on the street simply could not afford to buy durable and effective nets at the prices they commanded in the local market"

Before 2003 bed net coverage in Kenya was low and unequal with poorer households (like the family in Majengo) unable to afford them. Attempts to scale up coverage using social marketing (selling them at a subsidised price) were ineffective and inequitable - still poor people couldn't afford them. However, when the then Minister of Health, Charity Ngilu, became aware of the pioneering work of the Millennium Villages Project which had covered the entire community by distributing bed nets free of charge, government policy changed. Since then mass distributions of FREE bed nets and ongoing distribution through health facilities have covered the country. I believe national coverage is now around 70-80% and most importantly is reasonably equitably distributed. This is a fantastic achievement and as you rightly point out has contributed to a spectacular reduction in infant mortality in Kenya. Furthermore other countries have replicated this success, notably Ethiopia, Rwanda, Ghana, Burundi and Zambia.

However as the World Bank was instrumental in charging user fees for health services (like bed nets) in the first place, one feels that it is essential that the Bank now fully acknowledges the importance of removing them. Your blog, highlighting the importance of FREE nets, is therefore most welcome.