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200 CHAPTER 9 ■ Creating a Commercial Market for Insecticide-Treated Mosquito Nets

U.S. President’s Malaria Initiative (2001). All of these efforts have focused prima-
rily on the public sector. In 1999, the U.S. Agency for International Development
(USAID) created the NetMark Project—the first program focused entirely on har-
nessing the skills, investment, and infrastructure of the commercial sector to com-
bat malaria through the creation of commercially sustainable markets for
insecticide-treated nets (ITNs) in five to seven sub-Saharan African countries.
In Africa, malaria is carried by the night-biting anopheles mosquito; more
than 97% of infective bites occur between the hours of 10 p.m. and 6 a.m.
Sleeping under an ITN, therefore, is one of the best ways to prevent malaria. The
insecticide is deadly for the anopheles but poses little human health risk.
NetMark was issued for competitive bidding by USAID in 1999 and awarded in
September 1999 to AED, a nonprofit social development organization. It was
signed as a “cooperative agreement” instead of a “contract” because it was seen as
an experimental effort to determine if and how commercially viable markets for
ITNs could be established in multiple African countries and how far down the
economic scale commercial products could reach. There was no certainty it
would be successful.
At the start of NetMark, ITNs were available in African countries mainly
through donor and government programs. In most countries, they were not avail-
able in commercial markets; thus, families seeking the protection provided by ITNs
were not able to buy them. NetMark sought to change this situation by partnering
with international net and insecticide manufacturers to create retail markets for
ITNs in partnership with African distributors and retailers. For a variety of reasons
(e.g., prohibitive cost of educating consumers about ITNs, lack of market data,
competition from free and subsidized products, etc.), no ITN producers invested in
building retail markets but focused instead on the institutional market with its
large tenders from governments and donors. It was safe, clients were likely to pay
on time, orders were large, and it involved a simple response to an invitation to bid.
NetMark offered these commercial firms an opportunity to create retail markets
through its Joint Risk—Joint Investment Strategy. NetMark would carry out mar-
ket research, cover the heavy costs of educating the populace and creating con-
sumer demand for ITNs, help companies enter into the retail market, and serve as
a link with national malaria control programs and other public sector efforts to es-
tablish a supportive environment for the commercial marketing of ITNs. AED’s
Full Market Impact (FMI™) approach to public health social marketing addressed
all elements of the marketing mix in close collaboration with the public and pri-
vate sectors. FMI™ provided the framework for engaging the commercial sector,
nongovernmental organizations (NGOs), and the public sector in comprehensive
efforts to increase the practice of healthy behaviors and generate and fulfill de-
mand for an affordable and accessible range of public health products and services