Bednets – Universal Coverage or Universal Challenge

esther-lu-p3290235-sm.jpgWe have seen photos of challenging uses of long lasting insecticide treated nets (LLINs) from across malaria endemic countries.  Some donors may become indignant that their valuable, life-saving commodities are not being used as intended, or shall we say ‘misused’.

We must remember that use is in the eyes of the beholder.  We had similar challenges when distributing monofilament nylon water filters to prevent guinea worm. Many in the villages thought these were ideal for straining esther-lu-p3290234-sm.jpgcassava starch.  Innovations designed in one culture may not fit congruently into the life of another.

The various uses of LLINs reflect real perceived needs of the populations – a place to dry fish, a way to protect vegetables from pests, a beautiful wedding veil. So where does the problem lie. The attached photos by Esther Lu taken in the Karamajong NE District of Uganda add to our ‘net creativity’ portfolio.

esther-lu-p3280167-sm.jpgWe have seen over and over again that mass LLIN distribution campaigns are barely able to mobilize the resources to carry out the distribution, including getting enough nets to the right places at the right times. Not surprisingly few resources have been devoted to follow up and community-based health education by trusted community members.

So is misuse of nets a problem of recipients’ behavior or a problem of financing and planning by program managers?

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