Measuring Coverage - Unresolved Issues Two agreed numerators – “HH ownership” & “U5 slept last night” But denominator? All HH? Area? What is an ITN ? (public health view) – Quality of net – When does a net stop being “treated” ? Time Entomology Epidemiology – Source What is an ITN ? Consumer view

Subsidy Delivery Systems Planning Vouchers – Measuring commercial “availability”, “responsiveness” Comparing the cost effectiveness of alternative systems – Scale – Immediate impact vs sustainability – Direct vs indirect effects – Substitution – comparing impact of targeting different groups (geog. vs biol. vs econ.)

Stimulating Commercial Markets – Tracking sales - volumes and shares – Diverse market structures – Demand vs Supply = chicken and egg – Supply in remote areas – pull vs push – Local supply? Enabling Environment – Tax and tariff – what do we want? – Hidden costs and obstacles Overarching Questions

The Tanzania Story National Coverage 37% overall – 28% rural hh own at least one net – 80% in dar – 66% other urban Implies 20% (1.2-fold) growth p.a. since 1999 ~ mean annual growth in sales since 1994 Socioeconomic inequities reduced Voucher system to deliver targeted subsidies

Conclusions: The cup is half full ! Local systems Rapid & sustained capacity for growth Supply and demand grow together Competition: quality, efficiency, prices Equity issues Subsidies can complement, not replace