Insecticide-treated nets reduce malaria cases in coastal Kenya

 

Employer-based bednets scheme prevents malaria among workers in Kenya

In Kenya, an innovative scheme involving a community bednet-sewing industry, workplace promotion of bednets, and payroll purchasing schemes has helped reduce malaria cases and slashed overall health care costs. The public-private partnership venture has led to an increase in the use of bednets, higher profits for the community sewing industry, reduced absenteeism at work, and increased productivity among the employers involved.

In western and coastal areas of Kenya, a public-private partnership venture, involving workplace promotion of bednets and payroll purchasing schemes for employees, has helped reduce malaria cases as well as overall health care costs.

In one of the companies involved -- a cement company in coastal Kenya -- the number of malaria episodes among workers was reduced by over 80% between 1998 and 1999 and overall hospital admissions fell by almost 90%. Meanwhile, overall health care costs fell by over 20%. Elsewhere, the number of malaria episodes among workers was reduced by up to two-thirds, with related savings in health care costs.

The scheme, devised and managed by the Nairobi-based African Medical and Research Foundation (AMREF), has capitalized on the earlier success of a community bednet-sewing industry. The income-generating activity was launched by AMREF, with funding from Glaxo Wellcome, in an effort to encourage people to sleep under insecticide-impregnated bednets at night. At the time, supply and demand for bednets was very low in Kenya -- especially in rural areas -- mainly due to the high cost of imported bednets. Over 70% of the population are at risk of malaria, which accounts for 30%-50% of all childhood deaths.

In order to increase the supply of bednets and keep costs down, AMREF supplied community groups with sewing machines and netting material and launched a health promotion campaign to encourage sales. Over a 4-year period, the bednet-sewing industry took root -- producing over 5000 bednets for sale and fostering a growing practice of sleeping under bednets at night.

Then, in an effort to boost sales and increase bednet use still further, AMREF persuaded local private sector employers to purchase bednets from the community groups and offer them for sale to their employees through a company credit scheme or payroll deductions. The employers also agreed to involve their workers' health committees in efforts to promote the use of bednets and the need for regular re-treatment with insecticide. The initial 14 companies -- employing on average 1000 people -- included a brewery, a paper mill, a hotel chain, a mining company, and several sugar cane plantations. In the second phase, a further 14 companies have joined the scheme.

The arrangement suits everyone involved. As bednet sales increase -- over 13 000 had been sold by October 1999 -- a growing number of people are protected against malaria. With reduced absenteeism among the workforce, employers enjoy increased productivity and make savings on employee health care costs. And the community groups boost their income through increased sales of bednets.

This follow-up project, launched in collaboration with the Kenyan Government and funded by the UK Department for International Development (DFID), got off to such a successful start that demand rapidly overtook supply. And AMREF had to buy in ready-made bednets until production caught up. AMREF works closely with the bednet-sewing industry to improve products and encourage their distribution through sales representatives, pharmacies, and other retail outlets.

Experience has shown that one of the key factors determining the rate of sales to the workforce is the involvement of senior management in implementing the scheme. In some cases, frequent change of management has had an adverse effect on uptake. Elsewhere, especially in the sugar belt, employee purchasing schemes have been slow to get off the ground. Another problem has been the low rate of re-treatment of bednets -- due largely to the widespread misconception that the net alone provides adequate protection against mosquitoes.

AMREF hopes to ensure that the bednet-sewing industry is self-sustaining and can meet the increasing demand for bednets. Project funding and technical assistance ends in 2003. AMREF will continue to provide input up till then, whilst gradually transferring management of the project to the Kenyan Ministry of Health.