Beware of the funding trap

Juan Manuel Urrutia

‘When setting up treatment programs, you need a combined approach between the public and the private sector,' says Juan Manuel Urrutia of Netmark. He was addressing the Pan African Health Congress, held in Johannesburg on Tuesday and Wednesday, September 18 and 19.

‘the poor will need long-term free or highly subsidised medicines but the big challenge is: what happens when malaria is no longer the 'buzzword'?' he said. Unless a sustainable program has been established in the country itself, when donor funding ceases, so will the program - be it to provide antiretroviral or, in the case of Netmark, nets to counter the threat of malaria.

Netmark, which provides insecticide treated nets (Tins) to communities in malaria-prone areas, has achieved sustainability by setting up partnerships and liaisons between itself and commercial enterprises within the country itself.

‘There must be encouragement of ‘local' brands,' says Urrutia, and to that end, his organisation has helped about 40 manufacturers in Africa establish production facilities.

Urrutia's organisation works on a public/private approach; the ‘public' sector being the supply, distribution, affordability and demand aspects, and the ‘private' sector being the production, place, price and promotion aspects.

‘Through following this approach, we managed to get the prices of nets down by 30 to 70%, depending on the country. We have sold more than 50 million nets and thanks to the US$42 million investment by Netmark's 49 partners, the USAID cost per treated net is US$1.56.

So what are the challenges?

‘We need to agree on how to attribute results and measure impact,' says Urrutia.

Secondly, while Netmark has been working towards a progressive reduction of dependence on donor funding and greater commercially funded brand promotion, this is not has advanced as the organisation has hoped, but progress is being made.

The nets also have a ‘life' and will need to be replaced in time, and this to points to the need for sustainable local manufacture throughout Africa. To this end, the organisation is able to provide manufacturing equipment that can be tailored to the producer's capacity.

Other challenges that the organisation faces in promoting the use of its nets is the fact that some recipients don't use them because they claim that the nets are 'too hot'. Urrutia says in response that what needs to be promoted is the value of a good night's sleep.

A further challenge, in Kenya in particular, is the fact that the local custom in some areas is to cover the coffin of the deceased with a white net - and the treated nets are white. Hence, there is now a move to produce nets in green and other shades, and patterned, and this it is hope will see a reduction of the use of nets as shrouds.

The most effective brand promotion has a sequence and begins with awareness, then goes through image, understanding, availability, trial, retrial, and loyalty, with increases availability being crucial for long-term use and loyalty, says Urrutia.

If that is accomplished, then the long-term use of treated nets, plus interior residual spraying, will go a long way towards combating the spread of malaria throughout Africa.