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Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.

Mulligan JA, Yukich J, Hanson K - Malar. J. (2008)

Bottom Line: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established.The cost-effectiveness results are within the benchmarks set by other malaria prevention studies.The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. jo.mulligan@lshtm.ac.uk

ABSTRACT

Background: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.

Methods: Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted.

Results and conclusion: The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

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Tanzania National Voucher Scheme.
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Figure 1: Tanzania National Voucher Scheme.

Mentions: Implementation of the TNVS is through a public private partnership between the National Malaria Control Programme (NMCP), the district Council Health Management Teams (CHMTs), Reproductive and Child Health (RCH) facilities, private net manufacturers, over two hundred wholesalers, more than six thousand retailers and three non-governmental organisations (NGOs) contracted to the Ministry of Health. RCH staff and CHMTs are trained by World Vision Tanzania staff under a contract with the Ministry of Health and Social Welfare. Responsibility for voucher supply, distribution and redemption lies with the logistics contractor, Mennonite Economic Development Associates (MEDA), which procures vouchers and delivers them to district level. District Medical Officers (DMOs) are responsible for delivering vouchers to RCH facilities. RCH facilities distribute them to pregnant women who then redeem the vouchers for ITNs at local retailers (Figure 1). Redeemed vouchers are returned to wholesalers and then to manufacturers in exchange for new stock. Cash is provided against vouchers only at the very top of the system, to any of the four local manufacturers or a limited number of large wholesalers. This is to minimize the misuse of vouchers for products other than ITNs. A parallel system is used to supply free insecticide re-treatment kits to children attending vaccination clinics at three months and nine months, to encourage regular re-treatment of nets. The Medical Stores Department (an autonomous agency of the Ministry of Health) supplies insecticide re-treatment kits (IRK) directly to the districts through the distribution channels used for drugs and other medical supplies. A phased roll-out of the TNVS was launched in the first districts in October 2004, and all districts on the mainland were covered by May 2006.


Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.

Mulligan JA, Yukich J, Hanson K - Malar. J. (2008)

Tanzania National Voucher Scheme.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2279140&req=5

Figure 1: Tanzania National Voucher Scheme.
Mentions: Implementation of the TNVS is through a public private partnership between the National Malaria Control Programme (NMCP), the district Council Health Management Teams (CHMTs), Reproductive and Child Health (RCH) facilities, private net manufacturers, over two hundred wholesalers, more than six thousand retailers and three non-governmental organisations (NGOs) contracted to the Ministry of Health. RCH staff and CHMTs are trained by World Vision Tanzania staff under a contract with the Ministry of Health and Social Welfare. Responsibility for voucher supply, distribution and redemption lies with the logistics contractor, Mennonite Economic Development Associates (MEDA), which procures vouchers and delivers them to district level. District Medical Officers (DMOs) are responsible for delivering vouchers to RCH facilities. RCH facilities distribute them to pregnant women who then redeem the vouchers for ITNs at local retailers (Figure 1). Redeemed vouchers are returned to wholesalers and then to manufacturers in exchange for new stock. Cash is provided against vouchers only at the very top of the system, to any of the four local manufacturers or a limited number of large wholesalers. This is to minimize the misuse of vouchers for products other than ITNs. A parallel system is used to supply free insecticide re-treatment kits to children attending vaccination clinics at three months and nine months, to encourage regular re-treatment of nets. The Medical Stores Department (an autonomous agency of the Ministry of Health) supplies insecticide re-treatment kits (IRK) directly to the districts through the distribution channels used for drugs and other medical supplies. A phased roll-out of the TNVS was launched in the first districts in October 2004, and all districts on the mainland were covered by May 2006.

Bottom Line: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established.The cost-effectiveness results are within the benchmarks set by other malaria prevention studies.The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. jo.mulligan@lshtm.ac.uk

ABSTRACT

Background: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.

Methods: Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted.

Results and conclusion: The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

Show MeSH
Related in: MedlinePlus