Download Free distribution will always have a negative impact on the actual

CREATING SUSTAINABLE IMPACT THROUGH PUBLIC PRIVATE PARTNERSHIPS IN
THE FIGHT AGAINST MALARIA: Linking Free Distribution, Time Limited Subsidy,
and Sustainable Commercial Markets in Sierra Leone
Background
The entire nation of Sierra Leone experiences endemic malaria with a high-transmission
season that occurs eight to ten months of the year. Current coverage rates of Long Lasting
Insecticidal Nets (LLINs) are low, resulting in high morbidity and mortality rates due to malaria.
Only one out of seven households has an LLIN; a baseline survey conducted in 2005 revealed
that only 10% of children and 12.4% of pregnant women slept under a LLIN the night before
the survey.
In the efforts to scale up the use of LLINs in the fight against malaria, it has been established
that the best approach to achieve sustainable impact is to involve both the public and private
sectors (i.e. Public Private Partnership- PPP). In practice, such partnerships have met
challenges: the public sector strategy of free LLIN distribution often jeopardizes the efforts of
social marketing programs and/or the commercial sector.
In Sierra Leone, the various partners have collaborated closely to address these challenges
and close the gap between free public distributions, time limited subsidy and sustainable
commercial markets. In effect the partners are working to ensure that free distributions will
“prime the market” by educating and informing the public about the necessity and utility of
LLINs. Moreover, the partners will foster continuity between free distributions, subsidized
sales, and commercial sales through integrated social marketing and commercial marketing
campaigns. Though free distribution will always have a time-limited negative impact on
commercial markets,this impact has been managed in Sierra Leone such that the distributions
do not kill the commercial sector, but rather serve as a platform for growth and sustainability.
The Partners
All of the following partners collaborated to ensure synergy rather than competition in malaria
prevention efforts in Sierra Leone:
Partner
Role
Ministry of Health & Sanitation/ National
Malaria Control Programme
(MOHS/NMCP)
The World Bank (WB)
Government of Sierra Leone: owners of the health
program
Universat Logistics Company (ULC)
The local distributor implementing the social marketing
program and being supported to build capacity for
eventual commercial operation
Supplier of PermaNet® long lasting insecticidal nets
(LLINs) and funding agent for commercial marketing
activities
Vestergaard Frandsen S.A. (VF)
Funding the social marketing and distribution program
Canadian International Development
Agency (CIDA)
Canadian Red Cross (CRC)
Funding the Measles & Malaria Initiative (MMI)
Other donors/stakeholders
Participating in campaigns: Medecins Sans Frontiers
(MSF), CARE, Sierra Leone Red Cross (SLRC),
Implementing the Measles & Malaria Initiative (MMI)
CREATING SUSTAINABLE IMPACT THROUGH PUBLIC PRIVATE PARTNERSHIPS IN THE FIGHT AGAINST MALARIA
The Approach
Continuity
The diagrams below demonstrate the strategy of continuity between free distributions,
subsidized sales with social marketing, and commercial sales.
The Roll Back Malaria Partnership (RBM) Working Group for Scaling-up Insecticide-treated
Netting (WIN) has created a model for the sustainable promotion of LLINs.1 The model
attempts to find a balance between free and subsidized approaches, and sustainable market
development, which evolves over time. In the context of Sierra Leone, the model would include
targeted distributions to most vulnerable households through the MMI. Subsidy is provided by
the Social Marketing program, with funding from the WB. Finally, commercial sales are carried
out by Vestergaard Frandsen and ULC, building long term capacity for logistics and distribution
(Figure 1).
COMMERCIAL
VF’s retail set up
SUBSIDY
Social Marketing Program
FREE DISTRIBUTION
Measles & Malaria Initiative
TIME
Figure 1. WIN Model for the Sustainable Promotion of ITNs
These three programs operate concurrently in Sierra Leone, and instead of operating as
separate programs that compete with each other, the partners have all benefited from this
integrated approach. Thus there is a strong coordination to ensure that the immediate
objectives are achieved while building a strong and lasting platform in Sierra Leone.
Figure 2 illustrates more specifically the evolution of the social marketing and free distribution
program in Sierra Leone. The subsidy and social marketing program started in early 2006,
educating the population on the utility of LLINs and creating local demand. The MMI initiates
free distribution in November with about 875,000 LLINs. Meanwhile, the commercial marketing
program exists at a relatively small scale (delivered 330,000nets since 2004), but is expected
to grow steadily as the subsidy programs gradually diminish over many years as the
commercial market matures. However, future free distribution injections may be necessary to
assure access of LLINs to the poorest households, particularly when the effectiveness of the
MMI bednets declines after four years.
1
Roll Back Malaria, Scaling up Insecticide-treated Netting Programmes in Africa, August 2005
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CREATING SUSTAINABLE IMPACT THROUGH PUBLIC PRIVATE PARTNERSHIPS IN THE FIGHT AGAINST MALARIA
100%
75%
Commercial
Subsidy
50%
Free
25%
0%
COMMERCIAL
Figure 2. Social marketing – Entry And Exit
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