PROVIDER AND USER PERSPECTIVES REGARDING BEDNETS DISTRIBUTION STRATEGIES TARGETING MALARIA VULNERABLE GROUPS IN KWALE AND MAKUENI, KENYA

Malaria causes immeasurable human suffering in the tropics and the sub tropical areas. The disease is a leading cause for both mortality and morbidity with an estimated 300-600 million people being infected with malaria every year in the world. The World health Organization estimates that 90% of malaria deaths occur in Sub Saharan Africa. Insecticide Treated Nets (ITN) are a cost effective malaria control tool but coverage data has often showed that the majority of Sub Saharan countries are below the targets set by the Roll Back Malaria Initiative. While a lot of research has focused on the demand side perspectives of ITN uptake little has been done on the supply side factors affecting ITN coverage. This study establishes the distributor and user perspectives on ITN distribution strategies and whether they are reaching the poor and vulnerable to malaria. The study was descriptive cross sectional and was built on a larger study that explored access to malaria treatment and prevention among the poor. It was carried out in Kwale and Makueni Districts. Primary data arising from key informant interviews and semi structured interviews were used to gather the ITN distributor‘s perspectives. Secondary data arising from two cross sectional surveys carried out by the wider study gave the user perspectives of the bed net access. STATA version 9.2 was used to analyze the quantitative data while the qualitative data was analyzed using the thematic framework analysis. The study identified three main distribution strategies: free distribution (distributed through the mass campaign and routinely by Non Governmental Organizations), Social Marketed subsidized nets and commercial distribution of nets. All the distribution strategies deal with limitations that could be supplier related, logistical, market related or organizational. The majority of retail outlets had stopped selling bed nets and retail owners described the bed nets as a very slow moving product. Slightly over a half of the respondents in Makueni and just above a quarter of the respondents in Kwale said they could afford to purchase a bed net (76 (54%0 Makueni and 31 (17%) in Kwale). The free mass distribution was shown to have resulted in significant increase in bed net ownership in the two districts (from 88 (48%) to 124 (74%) in Kwale and from 76 (54%) to 102 (82%) in Makueni). In Kwale District people belonging to the high Social Economic Status (SES) were more likely to have benefited from the mass distribution exercise. In Makueni district, there was no association between a household’s likelihood of owning a bed net and its SES. Acceptability of bed nets was high in the communities studied. Statistical tests on the findings revealed that acceptability was related to bed net ownership. This study concludes that the mass distribution reaches the majority in a community and the strategy is effective at scaling up coverage in a short while. The commercial distribution strategy needs to be protected from collapse to ensure that bed nets are accessible and available throughout the year. Methods of ensuring that the poorest of the poor within the target groups are reached by all the strategies need to be explored to ensure that the poor benefit from the public health resources. Stringent monitoring and evaluation systems for existing distribution strategies need to be instituted to ensure early identification of bottlenecks, lesson learnt and correction for success of the program.