title: Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience.
abstract: BACKGROUND
  Malaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale.
  
  
  METHODS
  Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004.
  
  
  CONCLUSIONS
  National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries.
authors.affiliation: National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania. smagesa@nimr.or.tz
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Magesa
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
authors.forename: Don
authors.initials: D
authors.lastname: deSavigny
authors.forename: Jane E
authors.initials: JE
authors.lastname: Miller
authors.forename: Ritha J A
authors.initials: RJ
authors.lastname: Njau
authors.forename: Karen
authors.initials: K
authors.lastname: Kramer
authors.forename: Andrew
authors.initials: A
authors.lastname: Kitua
authors.forename: Alex
authors.initials: A
authors.lastname: Mwita
mesh_terms: D000818:Animals; D001512:Bedding and Linens / Q000191:economics; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D008288:Malaria / Q000191:economics / Q000517:prevention & control*; D009032:Mosquito Control / Q000191:economics / Q000379:methods* / Q000458:organization & administration* / Q000639:trends; D009313:National Health Programs; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors
chemical_list: D007306:Insecticides