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.