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Without a Net
Malaria kills a million people in Africa every single year. But it is a preventable disease, and now a unique public-private partnership is helping to spread awareness and increase the use of the best defense there is against it: treated mosquito nets.
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Produced by AED and USAID.

Learn more about NetMark's malaria prevention efforts.

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Segment 1

VOICEOVER
Gabriel Kisakye is four years old. A few days ago, he was just like this child: a normal, healthy young boy. Then, he was bitten by an anopheles mosquito. Now, he is desperately ill with malaria. The disease has taken hold. The next few hours will tell whether Gabriel lives or dies. Malaria kills almost 3,000 people in Africa every day. Every single day. One million lives a year. One million individual, preventable tragedies. But an innovative program with a logical solution has begun to help Africa prevent its malaria catastrophe. That program is called NetMark.
TITLE
Access to Survival
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Public-Private Partnership for Sustainable Malaria Prevention
VOICEOVER
Kampala, Uganda. The children's ward at the Mulago hospital. Gabriel Kisakye has been convulsing. It's a grave sign. The malaria parasite has reached his brain. Now, he's in a coma.
DR. PROSCOVIA MUGABA [Pediatrician, Uganda]
So, this particular child has an almost ... close to three-day history and is already very sick. He is deeply comatose.
VOICEOVER
Nearly every child in this ward is suffering from malaria. It is a tragedy being played out in hospitals, clinics, and homes all across sub-Saharan Africa. Half of all children born in Africa will contract malaria. One child in every 20 will die of the disease before reaching the age of five.
DR. PROSCOVIA MUGABA
So, he just had another convulsion.
VOICEOVER
Three hours since Gabriel was admitted, he's showing no improvement.
DR. PROSCOVIA MUGABA
I would put his case at 48 hours. The worst-case scenario is that he's likely to succumb, and he might die. And, with each convulsion, you have increasing damage to the brain.
VOICEOVER
Morning breaks over Kampala. In the children's ward at Mulago Hospital, there is an empty bed. Gabriel Kisakye has died.
DR. PROSCOVIA MUGABA
Because he began to have difficulty in breathing, which we think is most likely due to damage to the respiratory center, and he passed away at about 4am this morning.
VOICEOVER
Gabriel's parents grieve, and all across Africa parents like them suffer a similar tragedy. A child dies of malaria every 30 seconds. The true tragedy is that Gabriel's death was preventable. A week ago, he was a young boy about to start school, but a single bite from a mosquito as he lay sleeping has brought his future to an end.
DR. PROSCOVIA MUGABA
You can never get used to a child dying, because, first of all, when you think about it, they are dying from conditions that are totally preventable.
VOICEOVER
In the children's ward, another child is deathly ill. Malaria's grim cycle begins again. NetMark was established by the United States Agency for International Development, USAID, as part of a global effort to reduce the terrible burden of malaria in Africa. Implemented by AED, a non-profit human and social development organization, NetMark focused on a simple and proven method of preventing malaria: insecticide-treated mosquito nets known as ITNs. Starting in 1999, NetMark has worked in eight sub-Saharan African countries: Mali, Senegal, Ghana, Nigeria, Cameroon, Ethiopia, Uganda, and Zambia. In each of these countries, it was the accepted rule of public health authorities and development agencies to somehow get ITNs to those at risk of malaria. Most often, it was through free net distribution.
AISHA ISYAKU KIRU [Health Commissioner, Kano State, Nigeria]
There's a time when the free will stop, and when it stops, what next? So, it's very important to know that the issue of sustainability is the key.
VOICEOVER
NetMark developed a sustainable strategy it called Full Market Impact, which had three steps: to educate African consumers about the life-saving properties of insecticide-treated nets; to make nets commercially available throughout African retail markets, so they will be available forever, with or without donor support; and, finally, to make subsidized and free ITNs available to those who cannot afford to pay fully commercial prices. By sharing the burden of net distribution between the public and the private sectors, NetMark planned to use the best of both worlds to break malaria's grip on Africa.
JOSEPH ADDO-YOBO [NetMark West African Regional Manager]
We believe that the private sector has its expertise, and in the same way the public sector has unique expertise that the private sector can never have.
VOICEOVER
But first, NetMark had to convince international net and insecticide manufacturers, like Bayer, Vestergaard Frandsen, SiamDutch-Tana, A to Z Textiles, BASF, Syngenta, Sunflag, and Sumitomo that there was a potential retail market for ITNs. Not an easy task, given that the awareness and usage of insecticide-treated nets in Africa at the time was almost non-existent.
JENKINS BAKER [Vestergaard Frandsen Distributor, Ghana]
When we started here in the early 2000s, the culture of using nets was not anything that anybody took very seriously.
VOICEOVER
Before NetMark came along, major international net manufacturers like Vestergaard sold ITNs mainly to institutions like aid agencies and governments, but not the consumer retail market.
JOSEPH ADDO-YOBO
So, we were actually able to convince them that going into the retail market would not mean killing your institution or business. It would actually be expanding your market size and bringing in more resources.
JENKINS BAKER
And there would be a lot of incentives, such as free advertising and education to the population on how to use the net, and they will be responsible for that, and we should be responsible for the marketing and distribution, so we felt that this was a very good marriage, and therefore we decided to go on and get involved in it.

Segment 2

VOICEOVER
Having multinational ITN manufacturers like Vestergaard onboard meant hundreds of thousands of nets could be quickly made available through the retail market, but NetMark also wanted African entrepreneurs involved in the ITN business.
FIONA MIGADDE [CEO, Coopers Uganda]
Well, we were doing about 300 to 500 nets a month before we teamed up with NetMark.
VOICEOVER
Fiona Migadde, CEO of the Coopers company in Kampala, Uganda, wanted to expand her ITN manufacturing and distribution business from producing hundreds to producing thousands. Fiona was motivated not only by the potential profits to be made from a commercial ITN market, but also a humanitarian interest in helping tackle Uganda's most critical public health problem.
FIONA MIGADDE
The net business is very good because you get to give something, and it's immediate.
PROSSIE NAKATO [Coopers net stitcher]
You see a lot of people who die of malaria because they have not slept under mosquito nets. I lost my sister to malaria.
VOICEOVER
By working at Coopers, net stitcher Prossie Nakato is both earning a living and helping her local community become aware of how ITNs can help save their lives.
PROSSIE NAKATO
This job has enabled me to look after my brothers and sisters, to pay for school fees and pay the rent for where we live. It has also enabled me to know more about nets and spread the word to other people.
VOICEOVER
NetMark partners big and small have invested over USD$77 million in their own ITN businesses. That's about USD$1.43 for every USAID dollar invested. The idea is joint risk, joint investment -- using commercial funds to increase the total resources available and helping ensure sustainability when donor funds dry up. NetMark also helps its partners with marketing and distribution support, and state-of-the-art business skills.
ALLAN WERE [NetMark Country Manager, Uganda]
We trained the salespeople at Coopers. We trained them in things like bookkeeping and business management, in things like selling skills, marketing skills, and so on.
VOICEOVER
NetMark's consumer research showed that, if Africans were going to buy ITNs, they wanted a choice of different shapes, sizes, and different colors.
FIONA MIGADDE
We can be able to have the correct nets. You can have nets for schools, which have triple-decker beds, meaning they're much longer.
VOICEOVER
A choice in nets was a critical step in turning ITNs from a health item into a necessary household accessory, which, in turn, increased the market.
FIONA MIGADDE
We started pretty small, but now we've seen the business, is it called, "catching on like a bushfire"? It's just been spreading rapidly. The demand is overwhelming. We cannot believe. It's beyond our wildest dreams.
VOICEOVER
It may look like a small-scale operation but, from producing a few hundred nets a month, Coopers is now making and distributing 5,000 ITNs a month.
ALLAN WERE
Coopers is one of the companies you can look at and actually see that there is a commercial sector in countries like Uganda, and, if you did the right things, you can tap into it and actually achieve a public health impact.
VOICEOVER
In Kano, Nigeria, Happy Family Ventures, owned by Alhaji Abbati shows how a little help can go a long way. NetMark gave this small, net-stitching company a heat-sealing machine and insecticide treatment kits. These simple contributions allowed Alhaji Abbati to enter the ITN market in a big way.
ALHAJI ABBATI [Owner, Happy Family Ventures, Nigeria]
Over the past four years, with NetMark's assistance, we have produced and sold over 40,000 insecticide-treated mosquito nets.
VOICEOVER
NetMark helped Mr. Abbati be competitive in the market. His business took off because his ITNs were better quality than the untreated nets on the market.
ALHAJI SHERIFF [Shopkeeper, Nigeria]
Alhaji Abbati's nets are much better than the cheaper Chinese product, because the Chinese nets keep in the heat.
AISHA ISYAKU KIRU
Once a company starts producing nets, others will see that it is flourishing, because I know it will flourish. Others will see, and they will also want to do the same.
GARBA MUHAMMAD ABDUL [USAID Nigeria]
If NetMark were not there, in 2000, 2002, and upwards, nobody would have initiated, stimulated, production, marketing of nets, branding of nets, which was a major deviation from the previous practice. Nobody would have done that, because, so far, nobody is doing it.
VOICEOVER
NetMark worked with African advertising and marketing companies, launching public awareness campaigns tailored to each country.
NetMark TV ad
The night-biting mosquito is the only carrier of malaria. Malaria kills over two million people in Africa every year.
VOICEOVER
Their aim was to make everyone, regardless of income or educational level, aware that malaria could be prevented by using an insecticide-treated net.
NetMark TV ad
Get your new insecticide-treated net with the green NetMark seal of quality. Mosquitoes kill. Kill mosquitoes.
VOICEOVER
At this NetMark-sponsored education session in rural Senegal, Mrs. Ndao, a young mother of two, learns that aerosols or mosquito coils would cost her about USD$35 a year, while an ITN only costs her USD$6 and is far more effective in preventing malaria.
SEYNABOU NDAO [Mother]
I learned a lot from the education sessions about how to protect ourselves from malaria, the best solution to fight mosquitoes. Before, I used to buy the mosquito coils without knowing about the treated bed nets. Now, I know the net not only protects us against malaria, but saves us money.
FANA SYLLA SAKHO [NetMark Country Manager, Senegal]
NetMark has had a very important role in increasing the demand for ITNs through education and price reduction and by making the nets accessible to those who are most vulnerable to malaria.
VOICEOVER
Another major element in every public awareness campaign is what's called a road show. Local singers entertain the audience, while actors demonstrate the proper use of ITNs and run competitions with nets as prizes. This road show in urban Lagos is being run by Harvest Fields, a commercial partner in Nigeria.
MARTINS AWOFISAYO [CEO, Harvest Fields, Nigeria]
As you have seen today, anytime we go on a road show like that, we attract a crowd.
VOICEOVER
CEO of Harvest Fields, Martins Awofisayo, has seen a dramatic turnaround in public awareness of malaria and the effectiveness of ITNs.
MARTINS AWOFISAYO
The awareness that NetMark has done, on radio, on television, has made people know there is a net that can prevent malaria, and that is what we are having here.
VOICEOVER
In less than five years, Harvest Fields has gone from a small distribution company to the largest distributor of ITNs in Nigeria.
MARTINS AWOFISAYO
Nigerians are not all that poor. People can afford to buy them, as you have seen today. What nets we have brought here, we've sold out, so the market has tremendously increased, and, without NetMark, I don't think I would be talking to you today.
VOICEOVER
NetMark partners also carried out public awareness campaigns in boarding schools, the most common form of education in many African countries.
JOSEPHINE KAKULIREMU [School nurse, Uganda]
We used to have 1,000 cases of malaria per term, but nowadays, because of the use of Cooper nets, now we have 68, 50. It is really coming down, the numbers.
VOICEOVER
Here, at the Mugwanya School in Kampala, the infirmary, which used to be filled with boys suffering from malaria, is empty, and the classrooms are full.

Segment 3

VOICEOVER
NetMark believes in getting ITNs to those who need them by the best means possible, whether it be by developing the commercial market for nets or better targeting the distribution of free nets.
OLUWOLE ADEUSI [NetMark Country Manager, Nigeria]
In my language, there's a saying, [inaudible], which, in translation, means there is more than one entrance or exit to a market. We've been able to evolve. We tackle it from all angles. We make nets commercially available to all people who can afford them. We work also to ensure that people who are slightly at a disadvantage financially can afford and acquire those nets at a subsidized price, and then we make nets available free for those who are the poorest of the poor, for whom even basic feeding on a daily basis is a challenge.
VOICEOVER
When a retail market for ITNs exists, public health authorities and donors can more accurately and efficiently target those who cannot afford to pay commercial prices. USAID has sponsored this free ITN distribution in rural Nigeria.
OLUWOLE ADEUSI
We intend to distribute no less than 30,000 to 40,000 nets. The frenzy here is that so much awareness has been created about ITNs, net use, and the benefits. Sometimes, it's a bit difficult to get to the hinterland, to get to the poorest of the poor in society that really need this intervention. But that's where NetMark is different: we go where others do not.
VOICEOVER
Bridging the gulf between free and fully commercial ITNs is NetMark's discount voucher program.
OLUWOLE ADEUSI
We work with donors and corporate social organizations by providing funding, you know, to engage in targeted subsidy voucher schemes, for instance, in which pregnant women and children under five can actually avail themselves of a net at a subsidized price.
VOICEOVER
The subsidies have been funded by USAID, UNICEF, Exxon Mobile, the Global Fund, and national ministries of health. The subsidy voucher program allows low-income consumers to buy the net of their choice and preserves the dignity of those who cannot normally afford to buy their ITN.
JENKINS BAKER
For the people who cannot afford to pay outright for these nets, we have seen that it has brought a lot of progress in terms of sales and in terms of distribution of the nets, so, I would say that this was a brilliant idea.
VOICEOVER
Palunet was a tiny net distributor in Senegal before it became a NetMark partner. From distributing 2,500 nets a year in 2003, Palunet now distributes tens of thousands through the voucher system.
OUMAR BOYE [CEO, Palunet, Senegal]
If I made an addition of all the nets we've sold since 2003, we are around 500,000 nets sold in the voucher program, in the retail market, in nets sold to NGOs and something like this.
VOICEOVER
It's not only pregnant women, children, and commercial partners like Palunet who benefit from this voucher system. In Ghana, it has given rise to a type of micro-entrepreneur: the umbrella lady.
MAVIS NYARKO [Student and umbrella lady]
Because the vouchers help them to buy more. Since the voucher takes off 60 percent of the price, so it helps them to buy more.
VOICEOVER
Working outside the health clinics where the discount vouchers are given out, the umbrella ladies sell ITNs and make a small profit.
MAVIS NYARKO
Personally, it has helped me to generate income for my education. I am a student, yes. And, at the same time, people ... we are educating people about the use of the net. So, whenever they buy it, whenever they see me in town, "Oh, thank you. Because of you, now we are not having malaria," and then I feel happy.
VOICEOVER
Whether an umbrella lady or a larger African business partner, this targeted voucher program means almost all the donor funds go into the subsidies rather than the management of the program. If a voucher is not used, it's just a piece of paper, not an unused ITN.
GARBA MUHAMMAD ABDUL
So, I would say NetMark is a step ahead of most of our programs, and, in terms of sustainability, NetMark is far ahead of all of them I'd say, all of them put together.
VOICEOVER
In Senegal, the targeted voucher program works hand-in-hand with the country's unique, community-based healthcare infrastructure, called Health Committees, which operate in the most remote areas of the country. Mrs. Fatoumata Ka purchased an ITN at her local health community clinic with a voucher that covered 60 percent of the total cost. She and her young child are now safe from malaria infection, and donor funding has been precisely targeted to help those most at need. The voucher program has had a dramatic effect on malaria infection rates in this area and all across Senegal.
BOUBACAR SOW [Head nurse, Tassette Health Center, Senegal]
This year, we haven't had one single death, not one case of death of a child. So, really, the program is very important for the population, and it's a program that must continue.
VOICEOVER
Across Africa, across cultures, NetMark is still at work, whether it be in Senegal or Uganda. Since 2002, NetMark's full-market impact strategy has been developing successful and sustainable partnerships between public and private sectors, helping create retail markets for ITNs, in turn, helping African governments fight malaria.
DR. CONSTANCE BART-PLANGE [Director, National Malaria Control Program, Ghana]
And if Africa really wants to control malaria and get rid of malaria, there's no way public sector can go alone. You need the private sector. You need all the stakeholders on board, and, therefore, you need to tap other organizations that have the comparative strength and advantage to be able to rope in this private sector, and NetMark has that comparative advantage.
GARBA MUHAMMAD ABDUL
If NetMark was not there, there would have to be NetMark in another form and shape to do it, and that would have delayed getting to where we are today, and you know what that translates to? In Nigeria alone, that would have translated to more than two million deaths of children under five alone.
VOICEOVER
Since 2002, the commercial sector has sold over 46 million ITNs in NetMark countries. Since 2006, most sales have been of the new, long-lasting ITNs. NetMark has also educated more than 200 million people about the dangers of malaria and how insecticide treated nets can prevent it.
ALLAN WERE
Every Ugandan here who earns a salary, who is in formal employment, is able to afford an ITN. Every Ugandan in an urban town in Uganda, knows where they can find an ITN.
VOICEOVER
A vibrant market for ITNs now exists across Africa. More brands, more competition, means drastically lower prices, higher quality, reliable supply, and consumer choice.
DR. CONSTANCE BART-PLANGE
I remember at the beginning, a certain man came from outside the country to ask me a question: "Constance, when do you see that ITNs implementation has been successful in the country?" And I told him, "The day that, when you walk into any shop in Ghana, you can get a net, that will be the day that I can say that we have been successful." We are almost there.
VOICEOVER
NetMark and all its partners have one goal: that affordable, life-saving ITNs will be commercially available to most Africans long after NetMark leaves.
FIONA MIGADDE
So, they wanted us to know that they won't be here forever and that we have to know how to sell the nets even when NetMark is not here.
VOICEOVER
What used to be called charity is now truly an investment in the future of Africa. But it didn't happen overnight, and it is still a work in progress. Whatever it takes to save a child, a human life, whose death could be prevented, whose future could be protected, surely that is where we should be at our most creative. That was NetMark's challenge and its inspiration.
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46.5 million ITNs and 8.9 million insecticide treatment kits sold by NetMark's commercial partners between 2002 and 2008.
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1.6 million ITNs purchased by pregnant women and mothers of young children using discount vouchers at retail outlets.
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Over 2 million free ITNs distributed by NetMark and its commercial partners.
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ITNs are now between 30 percent to 70 percent cheaper than the cost of untreated nets before NetMark began.
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USD$77 million invested by NetMark's African and international commercial partners, with a cost to the U.S. taxpayer of USD$1.02 per ITN delivered.
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Over 200 million Africans educated on the importance and use of ITNs, particularly by pregnant women and children under five.
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[end credits]