Financing and distribution undertaken completely by the public sector is, however, only one of the options available. It would be possible, for example, for the public sector to finance nets which are distributed through the private sector, or for nets to be distributed through public sector channels with households meeting some, or all, of the costs. In reality, it is likely that different countries will develop different combinations of financing and physical distribution to suit their local needs, but the message of the cost-effectiveness analysis is clear. Governments should take an active role in stimulating the use of IMNs in areas where malaria mortality is high, and steps should be taken quickly to test efficient distribution mechanisms. Estimates are based on the costs incurred by the government of The Gambia in purchasing and distributing insecticide and organizing net impregnation in communities where people already owned nets.
Malaria is easily the biggest public health problem in Africa.
Some 90 percent of the world's more than 1 million deaths a year from malaria occur in Africa, but until the 1990s, control efforts were very weak, even though malaria has been getting worse and spreading. African ministers of health have already endorsed the use of the nets. The fourth study in a very malarious area of Burkina Faso is currently being analysed with results due in the summer of 1996. Villages were picked at random to receive or not to receive the nets, and followed for malaria cases for two years. Initial TDR economic analysis estimates that investment in nets would be comparable with global immunization programs for tuberculosis, measles and polio.