The Journey of a Malaria Bed Net

A behind the scenes look at how bed nets are saving lives in Madagascar — even in hard-to-reach places

A Malagasy man clings to the side of a truck delivering life-saving bed nets to communities at risk of malaria. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

Malaria is among the top five leading causes of death in Madagascar. The disease remains endemic for 90 percent of the country’s population of 26 million. Just one bite from a malaria-infected mosquito can be a death sentence.

Malaria has long been thought of as a disease that is controllable at best — but the global conversation is changing. Now, USAID is working to eliminate malaria, including in Madagascar.

Through the U.S. President’s Malaria Initiative (PMI), USAID and the Centers for Disease Control and Prevention are on the front lines in the fight against malaria.

Training health care workers, delivering rapid diagnostic tests and medicines, and implementing indoor residual spraying campaigns with effective insecticides are just some of the many ways that PMI is helping to eliminate malaria in Madagascar.

Perhaps most importantly, however, are the long-lasting insecticide-treated bed nets that PMI provides to at-risk Malagasy men, women, and children.

Malagasy men load malaria bed nets onto a cart in preparation for distribution. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

The bed nets work in two ways: they physically block mosquitoes at night — when they are most likely to bite — and they deliver a dose of insecticide that ultimately results in killing the mosquitoes.

“The use of [bed nets] is one of the most effective strategies to prevent malaria,” says Dr. Manana Alain Cadet from Tsinjomitondraka, a commune within in the city of Boriziny.

And the numbers add up — more bed nets delivered means more people are protected from malaria.

That’s why in 2018, PMI and the Global Fund set out to distribute 13 million nets across Madagascar.

These nets needed to reach 7,701 distribution sites in 106 different districts. Physically reaching these sites, however, was much more challenging than it may seem. Take Boriziny-Vaovao, for example. Located in the Sofia Region of western Madagascar, it is one of the 106 districts in the country and itself has over 100 distribution sites.

“The district of [Boriziny-Vaovao] has 103 distribution sites and 75 percent of them are in hard-to-reach and remote zones, which makes transportation very difficult,” says Andrianjara Rufin Stéphan from ASOS Madagascar, a Malagasy community health and social development organization that partnered with USAID on the net campaign. “However, we managed to transport all the nets safely.”

With slippery mud, bumpy roads, rivers to cross, and dense rainforests, how were we able to get these life-saving nets to the people who need them most?

Let’s follow the journey of a bed net in Madagascar to find out.

Bed nets are off-loaded from trucks into a warehouse in Antananarivo. / Anne Daugherty, USAID Madagascar

Six different means of transportation were used to get these nets where they need to be. The nets first arrived by ship to the east coast port city of Toamasina. They were then loaded onto trucks for a nine hour drive to Madagascar’s capital city of Antananarivo, where they were transferred to a central warehouse for national distribution.

A truck carrying nets travels on an accessible road in Madagascar. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

Once the campaign was underway, the bed nets were loaded onto sturdy trucks that are able to navigate areas with serviceable roads. Even here, drivers must maneuver with caution, as the roads can be rough and hazardous.

Once the nets reached roads that weren’t accessible by truck, they were moved onto carts pulled by zebu, a local breed of cattle.

Zebu pull carts loaded with malaria nets were used on less accessible roads. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

What happens when the nets reach a river? In this case, they were transferred into pirogues, or canoe-like boats.

Malaria nets are placed onto pirogues to be transported across a river. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

Last but not least, people carried the nets on their backs.

Malaria nets are carried by back during the final leg of the delivery journey. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

The journey required to transport a malaria bed net in Madagascar is no easy feat. Neither is the journey to a country’s self-reliance. However, with innovation, perseverance, and passion, we believe that we can accomplish both.

When communities have the resources and support to empower themselves, they can achieve self-reliance. Bed nets allow people to focus less on fears of malaria and more on the health, education, and economic development of their families, communities, and future generations.

“We are very happy to receive the nets,” says Florentine, a beneficiary from Boriziny. “Sleeping under nets allows us to stay healthy and perform our daily activities. Children can go to school and continue studying.”

Florentine, a beneficiary from Boriziny, unfolds her newly delivered insecticide-treated bed net. / Lan Andrian, USAID Global Health Supply Chain Program — Procurement and Supply Management

With PMI and the Global Fund’s support, over 20 million Malagasy people are now protected from malaria after receiving more than 13 million insecticide-treated mosquito nets.

It takes a ship, a truck, a zebu, a canoe, and a back to deliver life-saving malaria nets to millions of Malagasy people. It’s a challenge, but it is possible — and so is ending malaria for good.