In 2002 the UK Department for International Development in Kenya commissioned the Population Services International (PSI/Kenya) for an intensive five-year effort to implement the world’s largest insecticide-treated net (ITN) social marketing programme. The programme’s mandate was to reduce the incidence of malaria, especially among pregnant women and children under five, by creating a culture of ITN use.

Key targets for 2006 were:

  • 75 per cent household ownership of an ITN
  • 60 per cent of pregnant women and children under 5 sleeping under a net

Communication and distribution strategies were developed based on a scoping exercise, which recommended large-scale social marketing of branded products as the most effective means to increase ITN use rapidly, while stimulating and extending sustainable commercial distribution channels. 

Between 2001 and 2010, PSI/Kenya in partnership with the Division of Malaria Control distributed more than 19 million nets. Malaria admissions to hospitals in sentinel districts halved between 1999 and 2006, while under-5 mortality decreased by 36 per cent from 114 deaths per 1,000 births in 2003 to 74 deaths per 1,000 births in 2008/09. This drop was attributed to increased ITN and immunisation coverage.

Getting Started


Malaria on a global scale

Malaria is the main cause of death for children under 5, causing an estimated 34,000 deaths annually. In pregnant women, malaria causes anaemia, low birth weight, miscarriage and even maternal death. It is estimated that 10 to 20 per cent of maternal deaths are attributed to malaria.

Malaria in Kenya

Malaria is a major health problem in Kenya, with a disproportionate effect on the poor, pregnant women and children under five. Over 70 per cent of Kenya’s population, or over 27 million with a general population of 39 million people, are at risk of malaria, 75 per cent of whom live in rural areas. Malaria is not present in all parts of Kenya, but is a problem in Western, Coast, Nyanza, parts of Eastern and North Rift. Some communities suffer with malaria all year round and others just have breakouts from time to time.

Roll Back Malaria (RBM) Partnership

In 1998 the Roll Back Malaria (RBM) Partnership was launched by the World Health Organization (WHO), UNICEF, UNDP and the World Bank in an effort to provide a coordinated global response to the disease. One of its primary objectives was to have 60 per cent of pregnant women and children under 5 sleeping under mosquito nets by 2006. RBM later revised this objective to reach 80 per cent coverage by 2010.

In April 2000 an African Summit on RBM was held in Abuja, Nigeria with 44 of the 50 malaria-affected countries in Africa attending. They committed themselves to an intensive effort to halve the malaria mortality for Africa's people by 2010, through implementing strategies and actions for RBM, as agreed at the Summit. Among them was Kenya’s then President Daniel Arap Moi.

Population Services International (PSI) in Kenya

Founded in 1990, PSI/Kenya is a locally registered non-governmental organisation (NGO) dedicated to improving the health of Kenyans through the use of social marketing techniques to increase demand for, access to and use of essential health products.

PSI’s ITN work in Kenya began in 1998 with a pilot project funded primarily by the US Agency for International Development (USAID). The pilot was implemented in the coastal region and consisted of a net re-dipping service for a minimal fee. A mosquito net branded Supanet was launched in 2000 in Kilifi district. At that time the net was not packaged with a treatment kit.

Boy with mosquito net

For cost effectiveness and logistical reasons, a home treatment kit was developed to replace the re-dipping service. In April 2001, the Supanet was re-launched with a home retreatment kit (branded Power Tab) bundled with the net.

In 2001, the UK Department for International Development (DFID-K) contracted PSI/Kenya for an intensive 5-year effort to stimulate the emergence of an ITN culture, providing initial funds of US$25.4 million. This enabled the project to rapidly scale-up to reduce morbidity and mortality from malaria among children under five and pregnant women, through the use of ITNs and increasing net retreatment rates. Goals were set to achieve the Abuja ITN targets:

  • 42 per cent of households to own at least 1 net (later increased to 75 per cent)
  • 25 per cent of net-owning households in rural areas to have retreated their net in the last 6 months
  • 30 per cent of net-owning households in urban and peri-urban areas to have retreated their net in the last 6 months
  • 40 per cent of children under 5 in urban, peri-urban and rural areas to have slept under an ITN the previous night (later increased to 60 per cent)
  • 30 per cent of pregnant women in urban, peri-urban and rural areas to have slept under an ITN the previous night (later increased to 60 per cent)

supanet distribution

In addition, DFID-K approved for PSI/Kenya to develop a distribution strategy that relied exclusively on the private sector. By working with the private sector it meant that distribution would be better supported as it helped to create a sustainable market by establishing a regular supply of ITNs through the private sector distribution network and a consumer behaviour of purchasing mosquito nets. Furthermore the private sector is more aggressive in terms of reach. This means that even very remote rural villages would have access to purchasing a net.



The role of ITNs

Most malaria-carrying mosquitoes bite at night. Mosquito nets, if properly used and maintained, can provide a physical barrier to mosquitoes. If treated with insecticide, the efficacy of the net is greatly improved (from about 25 to 50 per cent) generating a chemical halo that extends beyond the mosquito net itself. This tends to repel or deter mosquitoes from biting or shorten the mosquito’s life span so they cannot transmit malaria infection.

There are several insecticides approved by the WHO Pesticides Board (WHOPES) for treatment of mosquito nets, but the most commonly used in Kenya are permethrin and deltamethrin. The price of a double-sized regular untreated net on the international market is approximately US$3.50 whereas the price for an insecticide treatment kit is approximately US$0.35.

Trials of ITNs in the 1980s and 1990s showed that use of ITNs can reduce malaria cases by up to 50 per cent and deaths of children under 5 by 20 per cent. In Kenya, an ITN efficacy trial conducted by the US Centers for Disease Control and Prevention (CDC) showed a 33 per cent reduction in child mortality. The results were equally dramatic in pregnant women, with a 21 per cent reduction in anaemia and 28 per cent decrease in low birth weight in infants.

The next generation of nets – long-lasting insecticide treated nets (LLITNs) – do not require retreatment at all. These nets come pre-treated with insecticide that remains effective for the life of the net. Two manufacturers received WHOPES approval in 2004. These nets cost approximately twice as much as a regular untreated nets packed with a treatment kit.


PSI/Kenya draws on a strong evidence base and much research was conducted to inform the programme:

  • Pre-2002, research was done on net preferences and net use. This was conducted through focus groups in localised sites
  • From 2000 to 2001 a knowledge, attitudes and practices (KAP) survey (household and individual questionnaire) was conducted on:
    • Knowledge of malaria and perception of risk
    • Malaria prevention and treatment
    • Knowledge and ownership of nets and ITNs
    • Decision making on net ownership and treatment
  • Retail audit that determined the extent of retail distribution, particularly in endemic areas
  • ITN usage and attitude survey (follow-up to KAP study)
  • A user survey and series of focus groups to gain a better understanding of Supanet and Power Tab users
  • Kenya Demographic Health Survey (KDHS)
  • Comparative country programmes, such as Malawi, provided guidance and learning


PSI/Kenya’s programme entered a market that already had providers of ITNs, who were a potential source of competition. However, analysis of the Kenyan market in 2001 to 2002 revealed:

  • The market was small, fragmented and limited in reach, especially in rural endemic areas
  • Retail sales of ITNs were estimated at less than 350,000 units, while the requirement for protecting the vulnerable population was estimated at over 13 million nets
  • Six medium-sized manufacturers of nets in Kenya, each sewing approximately 3,000 to 10,000 nets per month. Virtually no nets were imported due to a 20 per cent duty and 16 per cent value-added tax (VAT)
  • Ten net brands on the market, primarily available in large urban centres in textile shops and supermarkets. Virtually no nets were available in rural shops
  • Branding was very minimal and not very attractive to consumers, mostly consisting of a black and white leaflet mentioning the net brand and size
  • Consumer prices for a net were high, much higher than the international market rate as taxes and transportation costs were high
  • Both manufacturer and trade margins were also very high. Manufacturer operating margins were estimated at about 20 per cent and trade margins were even higher
  • Public and NGO sectors also distributed ITNs in Kenya, but there were no sustained interventions of significant size
  • Virtually no insecticide treatment for nets were available in the country in 2001


Man setting up mosquito net outside


PSI/Kenya’s programme uses an exchange mechanism that works on two levels:

  1. Population – Tangible national returns in terms of reduced mortality and morbidity, improved population health and the benefits this accrues (such as increased productivity and reduced disease burden)
  2. Individual – The consumer pays a small price (money, effort, inconvenience) in return for a tangible product (net), which provides health protection and peace of mind        

However, while the exchange seems obvious, a range of barriers prohibited uptake of ITNs. The programme works to promote the benefits of ITN use while minimising barriers wherever possible: 

  • Actual cost – Unfortunately ITNs can be expensive for families at risk of malaria, who are among the poorest in the world
  • Perceived value – Those unfamiliar with ITNs or not in the habit of using them need to be convinced of their usefulness and persuaded to retreat the nets with insecticide on a regular basis
  • Access issues – Especially in rural areas, buying ITNs is difficult

To overcome these barriers, PSI/Kenya needed to develop a sustainable commercial market with consumer ability and willingness to pay increasing as a result of directly experiencing the health and economic benefits of ITNs. It also needed to develop an effective communications strategy to highlight the benefits (health and economic) of ITNs.

women holding nets

Key insights

The research conducted helped to build an understanding of the customer and revealed a number of insights, which guided the programme’s development: 

  • Most Kenyans believed malaria risk to be uniform across groups, unaware that pregnant women and children under five were at increased risk
  • People were apathetic and fatalistic about malaria, considering it as part of normal life or not a problem
  • Less than 1 per cent reported sleeping under treated nets
  • There was a common perception that ITNs had lost their effectiveness
  • ITNs were often being used for other purposes (such as fishing nets) or saved for the future

This suggested that misconceptions and lack of information were preventing individuals from using ITNs. Therefore for the programme to be successful PSI/Kenya had to create a demand for the product, as well as provide a suitable supply chain. Demand would be stimulated using a strong social marketing campaign, which communicates messages like the health benefits of using a net, identifying those most at risk and dispelling myths surrounding net usage. 

Stakeholder engagement

The Kenyan Ministry of Health (MoH) provided leadership, the required policy framework and the country’s public health infrastructure. WHO played an advisory role and provided technical support while DFID provided most of the funding, with support from USAID. Key research also came from CDC and KEMRI (Kenya Medical Research Institute).

PSI/Kenya provided management, distribution, promotion, accountability and training through the government and commercial sector infrastructure. The commercial sector produced and distributed nets through the wholesale/retail chain, and a wide range of NGOs active in hard to reach areas carried out targeted delivery through community-based mechanisms.

Donkey-based distribution 

A formal launch of the programme was held to engage key stakeholders while briefings, meetings and reports were organised throughout to keep stakeholders updated with progress.



Communication and distribution strategies were developed based on the initial scoping work, which recommended large-scale social marketing of branded products as the most effective means to increase ITN use rapidly, while stimulating and extending sustainable commercial distribution channels.

Launched in early 2002, PSI/Kenya’s approach involved a three-pronged strategy for the first two years:

  1. Aggressive commercial sector distribution to widen the availability of nets in urban and rural shops and supermarkets
  2. Increasing affordability of nets through a two-tier subsidy, with a higher subsidy in rural areas
  3. Increasing demand for nets through an intensive national communication campaign. In addition, PSI/Kenya worked closely with the commercial sector to develop ways to increase the total net market in Kenya

Net distribution by boat


  • Three (two urban, one rural) different mosquito nets were marketed, all packaged with an insecticide treatment kit  
  • The urban net was dark blue or white in colour, conical shaped, double size and packaged with a Power Tab treatment kit. The conical shapes allows for one point of attachment
  • The rural net was green, rectangular, double size and also packed with Power Tab – green is less likely to show dust or dirt and the shape allows for attachment from four corners

Net demonstration


  • Wholesale: Two of the nets were available nationally at a 7 per cent subsidy, with the third targeted at rural areas at a 40 per cent subsidy
  • Consumer: The urban net was Ksh350, priced so as to not significantly undercut the existing commercial nets in the market, but low enough to exert price pressure on the commercial sector to reduce their margins and increase their volumes. The rural net was Ksh200


  • Urban: PSI/Kenya sold the nets through a network of urban distributors, who sold to wholesalers and retailers
  • Rural: PSI/Kenya sold nets directly to rural retailers on a cash basis, using a sales force of 10 representatives with Land Cruisers. To increase the rural reach of its ITN programme beyond existing retailers, PSI/Kenya built a network of 700 kiosks in rural malaria prone areas. Local entrepreneurs — identified with the help of community leaders and selected using strict criteria — operated the kiosks

Supanet presentation


PSI/Kenya sought to achieve its objective of increasing demand and consumer willingness to pay for ITNs and retreatment kits by:

  1. Increasing awareness among parents with young children and pregnant women that ITNs are the most effective protection from malaria
  2. Increasing knowledge about the importance of treating nets with insecticide
  3. Increasing consumer awareness of which household members are most vulnerable to malaria (pregnant women and children under five) so that they receive preferential access to nets

Supanet event with boat

Both a branded and unbranded campaign was developed.

Branded campaign:

  • Aimed to stimulate demand for the current Supanet and Power Tab products through radio, TV and print media
  • Supanet was targeted at pregnant women and parents of children under five with soft, family-oriented messages promoting the use of Supanet for malaria prevention
  • Power Tab was targeted at all mosquito net owners and revolved around a locally developed super action hero called ‘Mr. Power Tab’, who runs around smashing mosquitoes and protecting users from malaria

Unbranded campaign:

  • Aimed to grow the entire ITN market for general health promotion through the use of mass media (TV, radio and print)
  • Additional channels included interpersonal communications, such as antenatal clinic educational sessions, community drama, peer education in market places and rural community festivals
  • Examples of educational programmes included a 20-minute television documentary on malaria transmission and prevention, a radio soap opera that aired on national and regional television and mobile cinema units that circulated in rural areas
  • Involved a ‘shock’ campaign that intended to spur people into action against malaria – Malaria the silent killer. Research had shown that people are fairly apathetic and fatalistic about malaria and are not aware that pregnant women and young children are most at risk. The TV spots, radio and print messages thus depicted the worst case scenario, warning people that malaria could kill their unborn child or their young children, and the way to prevent this was to sleep under an insecticide-treated mosquito net

Kenya Child Malaria Campaign poster

2002 to 2004 results

It was planned from the outset to conduct household surveys every two years. The TRaC (Tracking Results Continuously) survey examined people’s knowledge, attitudes and use of ITNs and provided a way to ensure targets would be met. The results from the TRaC survey subsequently fed into the next distribution and communication strategy to facilitate further ITN reach.

In the first two years:

  • More than 1.2 million ITNs and 1.4 million retreatment kits were sold through commercial channels, significantly exceeding targets and expectations
  • A national survey conducted by PSI/Kenya in 2003 showed nearly a 10 per cent increase in household net ownership
  • The 2003 TRaC study showed significant increases in brand awareness: Supanet brand awareness increased from 27 per cent to 79 per cent and Power Tab from 0 per cent to 64 per cent
  • Awareness of ITNs as an effective malaria prevention strategy increased from 3 per cent in 2001 to 44 per cent in 2003

However, the increase in household ownership of nets and coverage of pregnant women and children under 5 years was much higher in urban areas (ranging from 27 to 59 per cent) than in rural areas (18 to 22 per cent). The branded communications strategy proved quite successful, with large increases in awareness noted through media research and the TRaC study. The generic communications material however was not highly memorable, as measured by media recall research, scoring significantly lower than the averages for this type of material. The TRaC survey showed that awareness about the high-risk groups only increased slightly, and was well below target. It was believed that the messages in this campaign were too negative and disjointed, thus people were tuning out the negative messages because most people do not like to hear bad news.

Two men putting up a mosquito net

A shift in distribution, pricing and/or communications strategy was urgently needed if the rural coverage targets were to be met by the end of programme. In addition, DFID-K and the Kenyan MoH were under significant external pressure to achieve the Abuja targets. So DFID-K:

  • Increased the national household coverage target to 75 per cent by 2006, with at least 60 per cent of pregnant women and children under 5 sleeping under a net
  • Provided US$89.6 million of additional funding through to March 2010
  • Allowed PSI/Kenya to utilise public sector clinics for the first time to distribute ITNs based on PSI/Kenya’s successful use of government health clinics in Malawi and CDC research, which demonstrated that this distribution channel effectively reached the most vulnerable groups
  • Decided that all nets in the commercial sector should be bundled with a treatment kit, agreeing to fund a 100 per cent subsidy on Power Tab so that all local manufacturers and importers of nets would be given Power Tab for free if they agreed to bundle all of their nets with the home retreatment kit
  • Asked PSI/Kenya to consider the medium- to long-term options on how to increase the role of the commercial net sector, especially given that some imported nets were able to compete with or even undercut the price of the subsidised brand Supanet. Options included leasing the brand name Supanet to local manufacturers, or withdrawing the Supanet from some markets where local brands were widely available

Remaining barriers

  • Price was still the biggest barrier to ITN sales in rural areas:
    • Wholesale – Most rural retail outlets could only afford to buy 5 to 20 nets at a time because of limited cash availability and PSI/Kenya did not offer credit
    • Consumer – Even at the subsidised price it was estimated that up to 40 per cent of rural consumers could not afford or were unwilling to purchase nets at that price
  • Public sector health facilities were generally understaffed, overworked and had never sold a product such as ITNs
  • The unbranded campaign was not sufficiently effective in increasing consumer awareness, particularly in rural areas



From 2004 to 2006 the main objective was to increase net ownership and use among rural at-risk groups and communities.

The new strategy, developed in conjunction with the MoH, was to:

  1. Price – Increase the subsidy on ITNs to rural communities and pregnant women and children under five
  2. Place – Increase the availability and affordability of the nets to pregnant women and children under five by selling them through health facilities
  3. Promotion – Create a new generic communications campaign that was branded to increase recall of the key messages

 Mothers waiting for net distribution

Increased subsidies

The subsidy on ITNs for rural communities was increased and the net price reduced from Ksh200 to Ksh100. The price of nets in urban areas was reduced by only Ksh30, from Ksh350 to Ksh320.

Delivery through antenatal clinics (ANCs)

The antenatal model was tested in the Coast region during the first half of 2004, during which demand and sales of nets increased four-fold. ITNs were delivered to ANCs directly by PSI/Kenya or indirectly via the local district hospital. ANCs purchased the nets and insecticide treatment kit for Ksh30 and sold them to pregnant women and caretakers of children under five for Ksh50. The Ksh20 margin provided a source of income for health facilities for infrastructure improvements and/or other recurrent costs. Nurses promoted the purchase and use of the nets by vulnerable groups during health talks and routine consultations. 

From September 2004 the model was rolled out to all 51 malaria prone districts in the country. Joint monitoring and supervision was routinely undertaken by PSI/Kenya and the District Health Management Teams (DHMTs).

In 2004 to 2005, LLITNs were introduced as part of the programme, but only sold through clinics to pregnant women and families with children under five. Although the LLITNs were twice as expensive as the bundled nets, DFID-K absorbed the extra cost and the price to consumers remained the same (Ksh50).

Training in ITN use

To build capacity among healthcare providers, PSI/Kenya, in conjunction with the MoH’s Division of Malaria Control (DOMC), trained over 6,400 healthcare providers in over 80 per cent of the public and mission health facilities countrywide in 2004 and 2005. This training focused on promoting purchase and use of ITNs in the context of broader malaria prevention and treatment messages.

Clinic Health Talk 

New generic ‘umbrella’ brand

Media results showed poor recall from the ‘shock and fear’ campaign and the team concluded the messages in this campaign were too negative and disjointed. They believed people were tuning out the negative messages because they did not like to hear bad news and there was nothing tying the messages together as a brand would do for Supanet and Power Tab.

Therefore, the team advocated a branded generic campaign that packaged the messages from the previous branded and unbranded campaigns under an umbrella slogan, which would identify the whole campaign and make it more memorable.

Malaria Ishindwe logo 

The new umbrella slogan became ’Malaria Ishindwe!’ (translated as ’Down with Malaria!’), which was developed using local research focus groups. Ishindwe is a Kiswahili word often used by preachers in the churches to invoke campaigns against evil things or the devil. The word has positive connotations among consumers and was memorable, readily understood and liked as a rallying cry to fight malaria.

There were three key messages to this campaign:

  1. To beat malaria, you have to sleep under a treated net
  2. You must know the people most at risk (pregnant women and children under five)
  3. You must retreat your net to keep your home a ‘malaria free zone’

Man on stage at large event 

These messages were disseminated through mass media and interpersonal communications, such as clinic programmes, community drama groups and road shows. They were aired in 2005 in three phases lasting three months each to ensure each message was understood and remembered by the target audience.

2007 to 2010

In 2006 and 2008 the Abuja targets were increased, which led to two grant extensions. In 2008 the new target was to ensure 100 per cent ownership and 80 per cent use by the end of 2010.

To meet these targets and as a result of the TRaC surveys, the communications and distribution strategies were further refined.

In 2007 to 2008, nets were provided free for pregnant woman and children under-one in areas previously included in the clinic distribution programme. In areas that had not participated in the programme the LLITNs were distributed for free to pregnant women and children under five. The rural net prices were halved to Ksh50. Furthermore, the private sector began to supply LLITNs to local net manufacturers, ensuring a greater reach.

Net distribution at a health facility 

Although high distribution had been achieved, the challenge that remained was how to align ownership and usage. A mass distribution evaluation study in 2006 reported that while net ownership was high, net usage was significantly lower, with a sizeable number of nets not even hung after distribution.

itn mother child

At this time the communications strategy was changed, drawing heavily on the insight that social norms were found to be the biggest driver and determinant of net use. In other words, consumers were more likely to purchase and use a net if they believed everyone was doing the same (Social Norm Theory). The new slogan is: 'Mbu Nje, Sisi Ndani (‘Malaria out, all of us in’).



In 2010 an external consultancy conducted a Project Completion Review (PCR) of PSI/Kenya’s ITN programme for DFID. They concluded: ‘This has to be one of the most successful health projects funded by DFID-K, with clear and measurable improvements in the health of significant numbers of Kenyans, many of them poor, which can be directly attributed to PSI/Kenya's programme and the funding from DFID-K over the past nine years.’

large queues for nets 


PSI/Kenya has distributed over 17 million nets – initially untreated bundled with insecticide, more recently LLITNs. Of these, 4.7 million have been free LLITNs. PSI/Kenya continues to market highly subsidised LLITNs in rural shops (over three million sold so far, though sales are declining as free LLITNs have become widely available). In urban areas, PSI/Kenya sold two million LLITNs before transferring the urban Supanet brand to a commercial company.

Total ITNs (including LLITNs) and treatment kits distributed, by year:



Treatment kits

























2010 - 31 March






Source: PSI/Kenya

The impact of these efforts on malaria in Kenya has been dramatic. Malaria admissions to hospitals in sentinel districts halved between 1999 and 2006, while under-5 mortality has fallen by 44 per cent which can be attributed to use of ITNs. Further, on the Kenyan Coast, a 28 to 63 per cent decline in paediatric malaria admissions was reported between 1992 and 2006 (O’Meara, 2008).

Experts agree that most of this impact can be attributed to nets (most of which have been funded by DFID), complemented by other governmental work. The project has thus achieved its goal to reduce malaria related morbidity and mortality among vulnerable populations.

Objective 1: 42 per cent of households to own at least 1 net (later increased to 75 per cent)

  • 2007 TRaC survey found that 65 per cent of households nationwide own at least 1 net, up from 43 per cent per cent in 2005

Objective 2: 25 per cent of net-owning households in rural areas to have retreated their net in the last 6 months

  • 62 per cent of rural households reported ownership of at least 1 net treated in the last 6 months or an LLITN

Objective 3: 30 per cent of net-owning households in urban and peri-urban areas to have retreated their net in the last 6 months

  • 74 per cent of urban households reported ownership of at least 1 net treated in the last 6 months or an LLITN

Objective 4: 40 per cent of children under-5 in urban, peri-urban and rural areas to have slept under an ITN the previous night (later increased to 60 per cent)

  • 62 per cent was achieved in 2007 and the target was increased again to 70 per cent in February 2010 (results are pending)
  • PSI/Kenya's own TRaC surveys in 2003, 2005 and 2007 and the KDHS in 2003 and 2008 show a steep rise in under-5s sleeping under a treated net













Source: PSI/Kenya TRaC Surveys

Objective 5: 30 per cent of pregnant women in urban, peri-urban and rural areas to have slept under an ITN the previous night (later increased to 60 per cent)

  • 48 per cent achieved in 2007 (February 2010 results pending)









Source: PSI/Kenya TRaC Surveys

The recorded fall in malaria reported above cannot be explained by any other change that has taken place in Kenya other than this intensive net distribution initiative.

Likewise, there is no explanation for the increased use of LLITNs by under-fives and pregnant women, other than the achievement of this programme’s outputs, which focus specifically on increased access to, knowledge of and positive attitudes towards treated nets.

Follow Up


The PCR makes eight recommendations for the new phase of ITN distribution, including:

  1. DFID-K should make sure PSI/Kenya's new 2010 to 2015 programme monitors (as planned) whether all women who come to the clinics are actually getting an LLITN, and how many of those who do get them are using or not using them as intended
  2. DFID-K should continue to fund the purchase and distribution of all LLITNs needed for routine distribution at ANC clinics in Kenya

 Supanet Xtra Power packaging

The report also confirms that PSI/Kenya’s research suggests the main driver of LLITN use is social norms – people use an LLITN because they believe their neighbours and peers are doing so. If this is indeed the case, then ongoing free distribution will in itself and over time gradually make non-users more of a minority. Therefore, by targeting everyone for ITN use it is hoped that this will encourage widespread use, including increasing usage among those groups most at risk.

Beyond 2010

The grant agreement has been further extended until March 2015. This new phase marks a policy shift towards universal coverage and an urgent need to increase consistent use of the nets. 

Research had shown that by just targeting vulnerable groups, other segments of the population stopped paying attention. Whole populations are now being targeted in malaria-prone areas.

Nurse poster 

The new campaign goal is to create consistent ITN users and build a sustainable net use culture by increasing the percentage of people who agree that ‘everyone around here sleeps under a net every night’. The campaign has the potential to evolve into a social movement where everyone in society feels empowered to use a net. 

To achieve this, more research is being conducted to successfully target all groups. An example is emersion research, where programme staff spend three to six days with a family to understand their day-to-day life. Furthermore, outreach activities, such as net hanging demonstrations, drama groups, roadshows and community mobilisation groups, continue to raise awareness about the benefits of using a net.

Lessons learned


As a result of moving to heavily subsidised nets, then to free distribution, there was a risk of leakage to the commercial market, which could potentially undercut their prices and damage the market. This was overcome by designing the urban and rural nets in a different shape and colour to make them easy to identify if they ended up in the wrong setting. More importantly, each net was batched and coded so they could be traced back to their supplier. Initially, suppliers caught leaking subsidised or free nets – whether they were an urban or rural supplier or even a health clinic – were blacklisted. However, the team realised the people being disadvantaged were the mothers and young children who no longer had access to subsidised or free nets. A new system is now in place whereby a report is filed with the government, who can then choose to take action, for example by suspending staff.

A coordinated approach is more impactful and useful than working alone. PSI/Kenya strongly advocates that if you want to ‘walk fast, walk alone’, but if you want to ‘walk far, walk together’. The more players involved – such as MoHs, funding bodies, research agencies and grassroots organisations – the more you can achieve. Furthermore, the earlier these partners can be brought on board the better, as it generates stronger ownership of the programme.

Another key lesson for success is the development of an appropriate strategy that makes best use of the comparative advantages of different partners in the public sector, commercial sector, NGOs and faith-based organisations. Utilising partners in the private sector (which sells an estimated half a million nets per year) to sell to consumers who are willing or able to pay for a net eases pressure on the public sector.

womens group poster

chief poster

father son poster

Key facts

Target audience





July 2001 to ongoing


Population Services International (PSI/Kenya)


US$115 million grant (2001 to 2010 period)