Worrall Eve, Hill Jenny, Webster Jayne, Mortimer Julia
Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
Trop Med Int Health. 2005 Jan;10(1):19-31. doi: 10.1111/j.1365-3156.2004.01355.x.
Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM 'Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa' promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM 'Workshop on mapping models for delivering ITNs through targeted subsidies' held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.
用杀虫剂处理过的蚊帐（ITNs）广泛覆盖弱势群体是控制疟疾的“击退疟疾”（RBM）战略的一个重要组成部分。《阿布贾目标》要求到2005年5岁以下儿童和孕妇的蚊帐覆盖率达到60%；但目前非洲的覆盖率低得令人无法接受。RBM的“非洲扩大杀虫剂处理蚊帐项目国家协调行动战略框架”促进国家协调行动，并倡导持续由公共部门提供有针对性的补贴，以最大限度地提高公共卫生效益，同时支持和刺激私营部门。一些国家已经在试点规模或全国范围内规划或启动了有针对性的补贴计划，并积累了宝贵经验，可为未来的干预措施提供参考。2003年在赞比亚举行的世卫组织RBM“通过有针对性的补贴提供杀虫剂处理蚊帐的绘图模型研讨会”提供了一个分享和记录这些国家经验的机会。本文汇集了研讨会上介绍的经验以及关于针对杀虫剂处理蚊帐、蚊帐处理套件和再处理服务（ITN产品）的补贴经验的其他信息，以描述替代方法，突出它们的异同，概述经验教训，并找出知识空白。我们发现，虽然关于针对ITN补贴的不同方法的知识越来越多，但在关键领域仍存在重大知识空白。关于如何最佳地确定目标、成本多少以及预期会有什么结果（覆盖率水平）等关键问题仍未得到解答。对针对ITN补贴的替代方法进行高质量、资金充足的监测和评估对于建立知识库至关重要，这样各国才能设计和实施有效的ITN补贴目标战略。
