Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review
Barbara A Willey, Lucy Smith Paintain, Lindsay Mangham, Josip Car & Joanna Armstrong Schellenberg
Volume 90, Number 9, September 2012, 672-684E
Table 4. Barriers to and facilitators of scaling up delivery of insecticide-treated nets (ITNs) in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria, by delivery strategy and implementation level
| Variable | Continuous |
Time-limited |
|||||
|---|---|---|---|---|---|---|---|
| At cost, partial subsidy or no subsidy; community-based |
Full subsidy; ANCa, |
Partial subsidy; ANC and MCH clinicsa, |
Partial subsidy; retail |
Free; stand-alone campaign |
Free; campaign integrated with public health campaigna, |
||
| User level | |||||||
| Cost | Barrierb | – | Barrier | Barrier | – | – | |
| Implementer/health system level | |||||||
| Functioning outreach system | Facilitator | – | – | – | – | – | |
| Lack of clarity of guidelines | – | Barrier | – | – | Barrier | – | |
| Training and supervision | – | Facilitator | Facilitator | Facilitator | Facilitator | Facilitator | |
| Implementation by provider not according to guidelines | – | Barrier | Barrier | Barrier | – | Barrier | |
| Health staff overburdened | – | – | – | – | – | Barrier | |
| Record keeping | – | Facilitator | Facilitator | – | – | – | |
| Stock-out of nets or vouchers | – | – | Barrier | Barrier | Barrier | Barrier | |
| Poor logistics for procurement or transport of nets | – | – | Barrier | – | Barrier | Barrier | |
| Policy level | |||||||
| Stakeholder involvement | – | Facilitator | Facilitator | Facilitator | Facilitator | Facilitator | |
| Cooperation between departments and ministries | – | Facilitator | Facilitator | Facilitator | Facilitator | Facilitator | |
| Instability of financing | Barrier | Barrier | – | Barrier | – | – | |
| Regulation amendment | – | – | – | Facilitator | – | – | |
ANC, antenatal care; MCH, maternal and child health.
a Information was principally from discussion sections of papers, with the following exceptions: stakeholder interviews in Ghana,31 Kenya26 and Nigeria51 and case study of scaling up ITNs in the United Republic of Tanzania.33
b For partially subsidised delivery by community volunteers in Zambia.21