Purpose
The U.S. Government established the NetMark Plus partnership to reduce malaria deaths in Africa through the creation of insecticide-treated mosquito nets (ITNs), a safe, low-cost and effective method of preventing malaria.  NetMark Plus aims to increase the availability and use of ITNs by focusing the reach and expertise of the public and private sectors.  This collaboration could have a major, positive impact on the health and economic status of sub-Saharan Africa.
 
Malaria kills more than 2 million people in Africa each year.  Between 300 and 500 million people suffer from malaria, the majority of which are young children; one out of 20 children in Africa dies of malaria before the age of 5.  Families are often forced to spend approximately 20% of their income on malaria treatments, and public health institutions spend up to 40% of their budgets on outpatient malaria treatment.  All told, in addition to the human loss and suffering, the disease results in an economic loss of $3 billion to African economies each year, slowing economic growth by approximately 1.3% annually.
 
The NetMark Plus partnership also supports the "Roll Back Malaria" initiative, a global partnership created to halve the world's malaria burden by 2010.  NetMark Plus is working to build commercial markets for ITNs in at least 10 African countries by expanding NetMark's partnerships with the commercial sector; defining best practices; advocating for policies that support an expanded role for the commercial sector; working with NGOs to expand access to ITNs in communities beyond the reach of commercial markets; and helping to introduce state-of-the-art ITN products, some of which will be manufactured in Africa.
 
Partners
Governments: Ghana, Mali, Nigeria, Senegal, Uganda, Zambia, and the United States Government (USAID).
International Organizations: UNICEF, World Health Organization, World Bank, and the Roll-Back Malaria Partnership.[km1]
Civil Society: Academy for Educational Development (AED), London School of Hygiene & Tropical Medicine; Johns Hopkins University, Department of International Health; and Population Services International
Private Sector: Net Manufacturers -- A-Z Textiles, Sunflag, Siamdutch Mosquito Netting Co, Vestergaard Frandsen; Insecticide Manufacturers -- Bayer Environmental Science and Syngenta; Consumer Marketing -- FCB Advertising, Exp Momentum; Distributors --Polyflex (Cameroon), Agrimat, Transcol (Ghana) Mossnet (Kenya), Agrivet (Madagascar), Beesago (Mali), Syngenta (Nigeria), CAD, SIMEX, and L'Aiglon (Senegal), Quality Chemicals (Uganda), Cropserve and Ecomed (Zambia).
 
Partnership Targets
NetMark Plus is implementing three complementary strategies to expand access to and use of ITNs in Africa.  These strategies include:

Providing Long Term Targeted Subsidies: NetMark Plus works to ensure that ITNs are available through partial or full subsidies that are targeted specifically to those who need them the most. The project supports ministries of health, NGOs and donors to expand access to ITNs.  Examples of how NetMark Plus supports targeted subsidy approaches include Senegal and Zambia, where coupons are redistributed to pregnant women through public health clinics so they can purchase ITNs from retailers at a discounted price. These activities are carried out in partnership with the ministries of health, IFRC, UNICEF and ExxonMobil.
 
Encouraging ITN Market Growth through Short Term Subsidies:  NetMark Plus makes strategic, time-limited investments intended to stimulate interest and use of ITNs among key opinion leaders in segments of the population who will encourage others to use ITNs.  In addition to stimulating demand for ITNs, this kind of market effort also introduces local distributors and retailers to ITNs as a potentially viable commercial product; it may even convince a local manufacturer to produce ITNs.
 
Supporting Unsubsidized Commercial Expansion for Sustainability: In order to assure access to ITNs by all segments of the population on a sustainable basis, the participation of the private commercial sector is critical. By engaging the commercial sector in promoting and selling ITNs to those who can afford to pay, the limited resources available from the public sector can then be used to subsidize ITNs for those who truly cannot afford to pay full costs. Competition is encouraged among these commercial partners to ensure customer access to higher quality and more affordable products. NetMark supports the efforts of more than 15 multi-national and locally based private sector partners in various countries to make ITNs available commercially.
 
Progress Towards Targets
As a direct result of NetMark Plus activities, commercial textile firms in Nigeria and Cameroon have expanded their manufacturing capacities of high quality and low-priced ITNs.  In some cases, this expansion has been met with the imposition of tariffs on the importation of ITNs, undermining the ability to meet the needs of all Africans.
 
As a result of NetMark Plus, Nigeria and other countries are helping local communities respond to the burden of malaria.  To date, the Partnership has sold more than 1.8 million nets in Ghana, Nigeria, Senegal, and Zambia and more than 1.7million insecticide re-treatment kits.  More than 2.5 million infants and pregnant mothers living in NetMark countries (Nigeria, Ghana, Zambia, Senegal, Uganda, and Mali) are protected from the threat of malaria.  In fiscal year 2004, the Partnership expects to expand into Ethiopia and Cameroon.  NetMark Plus continues to recruit multi-national and African companies that have expressed a desire to invest in and work with NetMark to reduce the threat of malaria. 
 
In May 2003, NetMark Plus hosted a pan-African workshop, "Mapping Targeted Subsidies for Insecticide Treated Nets," to review lessons learned on how best to deliver life-saving ITNs to pregnant women and infants. As a result of the workshop, a user-friendly guide is being created to give countries guidelines for implementing targeted subsidies of ITNs.  This guide will be available for broad distribution through the Roll Back Malaria Initiative Partnership by October 2003.
 
Next Steps

• In 2004, NetMark's goal is to generate sales of 3.5 million ITNs through the commercial sector in Africa, providing targeted subsidies for those unable to afford ITNs at market value;
• Launch NetMark activities in Ethiopia and Cameroon;
• Access transnational distribution networks - including looking for additional distribution partners who operate trans-nationally; 
• Promote improved ITN technologies by encouraging net and treatment manufacturers to accelerate the development of long-lasting and permanently treated nets and longer-lasting net treatments; and
• Increase the geographic scope of the NetMark Plus market, expanding from pilot interventions to large-scale regional interventions in several countries.  

Resources
To date, USAID has provided $22.4 million to the NetMark Plus partnership.  These resources include $3.5 million to launch national programs in Uganda, Ghana and Mali bringing the total number of countries with national-level efforts to six African countries.  USAID has also expanded its existing NetMark Program, from a five-year, four country $15.4 million program, to an eight-year sub-Saharan-wide $65.4 million program.  Commercial investments through NetMark Plus to date are 40 cents for each NetMark dollar spent.

U.S. Government Primary Points of Contact
Agency for International Development: Dennis Carroll (Telephone: 202-712-5009; E-Mail: dcarroll@usaid.gov)