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NATNETS Programme Tanzania
Results from the Results from the NATNETS Programme NATNETS Programme
National Malaria Control National Malaria Control Programme TanzaniaProgramme Tanzania
Presentation for RBM / WINPresentation for RBM / WINMarch 1-3 2006March 1-3 2006
Nick Brown, ITN Cell Team Leader, NMCPNick Brown, ITN Cell Team Leader, NMCP
NATNETS Programme Tanzania
NATNETSNATNETS
ITN Cell in the National Malaria Control ITN Cell in the National Malaria Control Programme (funded by Swiss Agency for Programme (funded by Swiss Agency for Development & Cooperation)Development & Cooperation)
Tanzania National Voucher SchemeTanzania National Voucher Scheme (funded by (funded by GFATM Round 1)GFATM Round 1)
SMARTNET Social Marketing Programme SMARTNET Social Marketing Programme (funded by DFID/RNE)(funded by DFID/RNE)
A long-term multi-donor, multi-partner initiative to A long-term multi-donor, multi-partner initiative to promote the national use of ITNs made up of promote the national use of ITNs made up of three complementary interventions:three complementary interventions:
NATNETS Programme Tanzania
ApproachApproach
Establishing and promoting the ITN Establishing and promoting the ITN
Public Private Partnership to ensure:Public Private Partnership to ensure:
AffordabilityAffordability
AccessibilityAccessibility
AcceptabilityAcceptability
NATNETS Programme Tanzania
Tanzanian National Voucher SchemeTanzanian National Voucher SchemeThe Four Contracting PartnersThe Four Contracting Partners
LogisticsLogistics: Voucher printing, distribution, : Voucher printing, distribution, administration and redemption: MEDAadministration and redemption: MEDA
Training & PromotionTraining & Promotion: World Vision Tanzania / : World Vision Tanzania / CARECARE
Monitoring & EvaluationMonitoring & Evaluation: LSHTM / Ifakara HRDC: LSHTM / Ifakara HRDC
AuditAudit: KPMG: KPMG
NATNETS Programme Tanzania
MEDA /
Namitech
Wholesalers
Manufacturers
District Medical Officers
& RCH Clinics
Pregnant
WomenRetailers
Voucher Books
Individual VouchersRedeemed
Vouchers
Redeemed Vouchers
The TNVS Voucher Flow
Individual Vouchers
Redeemed vouchers
NATNETS Programme Tanzania
TNVS Voucher Value & Prices of NetsTNVS Voucher Value & Prices of Nets
Tzs 2,750 ($2.50 approx)Tzs 2,750 ($2.50 approx)
Retail Net prices vary from Tzs. 3,500 - 4,450 depending Retail Net prices vary from Tzs. 3,500 - 4,450 depending on size of net and remotenesson size of net and remoteness
All nets manufactured in Tanzania are bundled with an All nets manufactured in Tanzania are bundled with an Insecticide Treatment KitInsecticide Treatment Kit
Top Up paid by women varies from Tzs 750 – 1700 Top Up paid by women varies from Tzs 750 – 1700 (average = 1,019)(average = 1,019)
Top Up price represents retailer’s marginTop Up price represents retailer’s margin
Retailer can only exchange vouchers for more netsRetailer can only exchange vouchers for more nets
NATNETS Programme Tanzania
Achievements of TNVS Achievements of TNVS
>1.27 million vouchers distributed to DMOs and >1.27 million vouchers distributed to DMOs and clinics by the end of 2005clinics by the end of 2005
Hati PunguzoHati Punguzo is now operational in all 21 Regions is now operational in all 21 Regions
National Coverage (last remaining districts) will be National Coverage (last remaining districts) will be achieved by early April 2006achieved by early April 2006
NATNETS Programme Tanzania
Hati Punguzo Hati Punguzo vouchers issued to vouchers issued to DMOs and clinics by 2005 year endDMOs and clinics by 2005 year end
Vouchers Issued
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Q2 Q3 Q4 Q5 Q6
Actual
Target
NATNETS Programme Tanzania
Hati Punguzo Voucher Hati Punguzo Voucher Redemption RatesRedemption Rates
414,878 vouchers 414,878 vouchers redeemed by the redeemed by the year endyear end
Currently >545,000 Currently >545,000 vouchers redeemedvouchers redeemed
Voucher redemption Voucher redemption rates exceeded the rates exceeded the monthly target for the monthly target for the first time in first time in December 2005December 2005
Vouchers Redeemed
0
10000
20000
30000
40000
50000
60000
70000
80000
Oct-05 Nov-05 Dec-05
Target
Actual
Cumulative Total Number of Vouchers Redeemed
0
100,000
200,000
300,000
400,000
500,000
Q2 Q3 Q4 Q5 Q6
NATNETS Programme Tanzania
Growth of the Commercial Sector Growth of the Commercial Sector stimulated by TNVSstimulated by TNVS
Four Tanzanian Net ManufacturersFour Tanzanian Net Manufacturers A-ZA-Z SunflagSunflag TMTLTMTL MotexMotex
WholesalersWholesalers
RetailersRetailers
NATNETS Programme Tanzania
Growth of the Commercial Sector Growth of the Commercial Sector stimulated by TNVSstimulated by TNVS
Number of Retailers and Wholesalers
0
500
1000
1500
2000
2500
3000
Q2 Q3 Q4 Q5 Q6
Wholesalers
Retailers
ITNs are now widely ITNs are now widely available in remote rural available in remote rural areas due to growth of areas due to growth of the retail sectorthe retail sector
2,618 retailers involved 2,618 retailers involved by end Decemberby end December
80% of these retailers are 80% of these retailers are new to the ITN businessnew to the ITN business
NATNETS Programme Tanzania
Growth of Commercial ITN Sales and Growth of Commercial ITN Sales and Re-Treatment KitsRe-Treatment Kits
Sales of ITNS in 2005 Sales of ITNS in 2005 reached 2.4 million, reached 2.4 million, 34% higher than 200434% higher than 2004
Sales of insecticide Sales of insecticide re-treatment kits re-treatment kits (IRKs) > 3.175 million, (IRKs) > 3.175 million, 44% higher than 200444% higher than 2004
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2001 2002 2003 2004 2005
Sales of Bednets in Tanzania 2001-2005
Unsubsidised Nets LLINs TNVS Voucher Sales Free Nets
0
1,000,000
2,000,000
3,000,000
4,000,000
2001 2002 2003 2004 2005
Growth of Insecticide Re-Treatment Kits 2001-2005
Commercial Sales of Ngao Retreatment Kits IRKs Distributed under TNVS
NATNETS Programme Tanzania
Other Achievements of TNVSOther Achievements of TNVS
As a result of TNVS, As a result of TNVS, clinics are reporting clinics are reporting increased attendance and increased attendance and are seeing women earlier are seeing women earlier in their pregnancyin their pregnancy
In launched districts In launched districts awareness of awareness of Hati Hati Punguzo Punguzo ranges from ranges from 52% (household heads) 52% (household heads) to 71% (pregnant women to 71% (pregnant women leaving clinics)leaving clinics)
01020304050607080
HouseholdHeads (HS)
PregnantWomen (HS)
RCH Users (ES)
Awareness of Hati Punguzo in Household (HS) and Exit (ES) Surveys (June-Aug 2005)
Not Launched TNVS Launched
NATNETS Programme Tanzania
Bednet Coverage EstimatesBednet Coverage EstimatesPregnant Women (HH Surveys)Pregnant Women (HH Surveys)
These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS
Early launched districts were closer to Dar es Salaam and probably had higher Early launched districts were closer to Dar es Salaam and probably had higher coverage to start withcoverage to start with
Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched
Show Desktop.scf
0.0%
10.0%
20.0%
30.0%
40.0%
Late Middle Early
Coverage Estimates by TNVS Launch Status from LSHTM/IHRDC Household Survey
(June-Aug 2005)
Coverage (ITN)
Coverage (untreated net)
NATNETS Programme Tanzania
Bednet Coverage EstimatesBednet Coverage EstimatesChildren <5 (HH Surveys)Children <5 (HH Surveys)
0.0%
10.0%
20.0%
30.0%
40.0%
Late Middle Early
Coverage Estimates (<5s) by TNVS Launch Status from LSHTM / IHRDC Household Survey (June-Aug
2005)
Coverage (ITN)
Coverage (Untreated)
These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS Early launched districts were closer to Dar es Salaam and may have had higher coverage to start Early launched districts were closer to Dar es Salaam and may have had higher coverage to start
withwith Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched
NATNETS Programme Tanzania
Bednet Coverage EstimatesBednet Coverage EstimatesPregnant Women (Exit Surveys)Pregnant Women (Exit Surveys)
These differences cannot only be attributed to the TNVSThese differences cannot only be attributed to the TNVS
Early launched districts were closer to Dar es Salaam and may have had higher Early launched districts were closer to Dar es Salaam and may have had higher coverage to start withcoverage to start with
Early and Middle launched districts had higher SES than late launchedEarly and Middle launched districts had higher SES than late launched
0%
20%
40%
60%
80%
Late Middle Early
Coverage Estimates by TNVS Launch Status from LSHTM / IHRDC Exit Survey
(June-Aug 2005)
Coverage (ITN)
Coverage (untreated net)
NATNETS Programme Tanzania
Bednet Coverage by Socio–Economic Status Currently Bednet Coverage by Socio–Economic Status Currently Pregnant Women (from LSHTM/IHRDC HH Survey Pregnant Women (from LSHTM/IHRDC HH Survey
June-Aug 2005)June-Aug 2005)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Q5 (leastpoor)
Q3 Q1(poorest)
Any Net
Ever Treated
Recently Treated
NATNETS Programme Tanzania
Current & Future Bednet Current & Future Bednet Coverage EstimatesCoverage Estimates
Since the household and exit surveys were Since the household and exit surveys were conducted, a further 375,000 vouchers have conducted, a further 375,000 vouchers have been redeemed by pregnant women, been redeemed by pregnant women, representing 27% of the estimated PW representing 27% of the estimated PW populationpopulation
A further 375,000 vouchers are expected to be A further 375,000 vouchers are expected to be redeemed within the next four months, prior to redeemed within the next four months, prior to the next round of M&E surveysthe next round of M&E surveys
NATNETS Programme Tanzania
IssuesIssues
Widespread shortages of ANC Widespread shortages of ANC cards in many (40) districts cards in many (40) districts means many women are being means many women are being denied a voucherdenied a voucher
GFATM Phase 2 Agreement GFATM Phase 2 Agreement Letter still unsigned, four Letter still unsigned, four months after commencement months after commencement of Phase 2.of Phase 2.
Women in poorest socio-Women in poorest socio-economic group (Q1) are economic group (Q1) are >50% less likely to be given a >50% less likely to be given a voucher as the least poor voucher as the least poor group (Q5)group (Q5)
0%10%
20%
30%
40%
50%
60%
Q5 (leastpoor)
Q4 Q3 Q2 Q1(poorest)
Probability of Pregnant Women Being Given an HP Voucher according to Socio-Economic Status
(Source: RCH Exit Surveys June-Aug 2005)
NATNETS Programme Tanzania
TNVS Programme CostsTNVS Programme Costs
Once nationwide coverage is achieved, 1.1-1.2 million nets will Once nationwide coverage is achieved, 1.1-1.2 million nets will purchased with vouchers per yearpurchased with vouchers per year
Annual cost of Phase 2: $5.5 millionAnnual cost of Phase 2: $5.5 million
Price per net delivered incl. subsidy, 2 re-treatment kits, logistics, Price per net delivered incl. subsidy, 2 re-treatment kits, logistics, training, promotion, audit and administrationtraining, promotion, audit and administration
= $4.55 - $4.96 = $4.55 - $4.96 eacheach
Delivery cost (logistics, training, promotion, audit & admin): Delivery cost (logistics, training, promotion, audit & admin):
=$1.79 - $1.97 per =$1.79 - $1.97 per netnet
NATNETS Programme Tanzania
Next StepsNext Steps
Advocacy and Retraining Programme to address the Advocacy and Retraining Programme to address the right of right of allall pregnant women to receive vouchers pregnant women to receive vouchers (March/April)(March/April)
Introduction of KO Tab 123 (April onwards)Introduction of KO Tab 123 (April onwards)
Feasibility study for transfer of factory pre-treatment Feasibility study for transfer of factory pre-treatment technology to Tanzanian manufacturers (current)technology to Tanzanian manufacturers (current)
Additional subsidy for 200,000 OlysetAdditional subsidy for 200,000 Olyset™ nets™ nets
USAID/PMI ProgrammeUSAID/PMI Programme
NATNETS Programme Tanzania
Expanding the TNVSExpanding the TNVSUSAID/PMI Programme 2006USAID/PMI Programme 2006
Infant Voucher in 15 RegionsInfant Voucher in 15 Regions
Equity (“Safety Net”) Voucher in 12 Equity (“Safety Net”) Voucher in 12 DistrictsDistricts
Long Lasting Insecticide Treated Net Long Lasting Insecticide Treated Net (LLIN) Technology Transfer(LLIN) Technology Transfer
NATNETS Programme Tanzania
TNVSTNVS Infant VoucherInfant Voucher
Delivered at 9 months with measles Delivered at 9 months with measles vaccinationvaccination
Value = Tzs 2750 (same as PW voucher)Value = Tzs 2750 (same as PW voucher) Funding in Year 1 to reach 15 RegionsFunding in Year 1 to reach 15 Regions Selection CriteriaSelection Criteria
Infant MortalityInfant Mortality Excluding regions and districts that have Excluding regions and districts that have
recently received free netsrecently received free nets
NATNETS Programme Tanzania
TNVS Equity VoucherTNVS Equity Voucher
Targeted at the most needyTargeted at the most needy
Selection and Delivery Mechanism to be determinedSelection and Delivery Mechanism to be determined
Probably a top-up voucher over and above the PW & Probably a top-up voucher over and above the PW & Infant VoucherInfant Voucher
Value to be determined (range Tsh 750 -1500) if a top upValue to be determined (range Tsh 750 -1500) if a top up
Funding in Year 1 to reach 12 districtsFunding in Year 1 to reach 12 districts
District Selection by Poverty Indicator & Infant MortalityDistrict Selection by Poverty Indicator & Infant Mortality
NATNETS Programme Tanzania
Next Steps - Medium TermNext Steps - Medium Term((Subject to full approval of PMI programme)Subject to full approval of PMI programme)
Expansion of Infant Voucher from 15 to all Expansion of Infant Voucher from 15 to all 21 regions (from 2007)21 regions (from 2007)
Introduction of <5 voucher (from 2007)Introduction of <5 voucher (from 2007)
Expansion of Equity Voucher (2007-2010)Expansion of Equity Voucher (2007-2010)
NATNETS Programme Tanzania
AcknowledgementsAcknowledgements Our donorsOur donors
GFATMGFATM SDCSDC DCIDCI DFID/RNEDFID/RNE
Swiss Tropical InstituteSwiss Tropical Institute
Our Contracting PartnersOur Contracting Partners MEDAMEDA World Vision / CAREWorld Vision / CARE LSHTM / IHRDCLSHTM / IHRDC PSIPSI KPMGKPMG
The Tanzanian Net ManufacturersThe Tanzanian Net Manufacturers
Karen KramerKaren Kramer