Started in October 2004 by the Ministry of Health (MoH) under the National Malaria Control Program (NMCP), the Hati Punguzo program aims at preventing malaria infection amongst pregnant women and children under five years by increasing the use of insecticide-treated nets (ITNs).

The initial target group during the program start was pregnant women, who receive a discount voucher, the "Hati Punguzo," on their first visit to a Reproductive and Child Health (RCH) Clinic. The voucher can then be exchanged for an ITN, with a small top-up amount, at authorized retailer shops carrying the Hati Punguzo sign. In the third year the program expanded to include infants and children under five years in some selected areas. Recently, the program has been extended to Zanzibar.

Hati Punguzo vouchers are distributed to pregnant women and mothers of infants through more than 4,200 RCH clinics, redeemed at more than 6,600 retailers, with 260 wholesalers supporting ITN distribution.  

The program started with a pregnant women voucher worth TShs. 2,750=, approximately 75 per cent of the average commercial price of an ITN at that time. When the price of ITN went up, the program revised the value to TShs 3,250.

The program is implemented through a partnership of four contractors, categorized by specific activities. These are:

1. MEDA – logistics: voucher printing, distribution, administration and redemption
2. World Vision (WV)Tanzania / CARE - training and promotion
3. LSHTM / IHRDC - monitoring and evaluation
4. KPMG - auditing

The program's structure has been designed with a vision to stimulate healthy economic growth in the private sector through which communities in the most remote areas can have access to ITNs. The program's successes lie in the cooperation of key stakeholders from a number of different sectors inter-linked through the concept of public private partnership (PPP). Each stakeholder plays an essential role in making sure that the program's primary objective is fulfilled. This is done in three key ways:

1. Increasing affordability of ITNs: through a voucher given to pregnant women to subsidize the cost of an ITN
2. Increasing accessibility of ITNs: through contracting retailers who will stock ITNs even to the most remote area
3. Increasing awareness about malaria prevention by promoting the proper use of ITNs

In June 2006, the program celebrated the scanning of a millionth voucher. Now, eighteen months later, the program has tripled the number of beneficiaries receiving ITNs through the voucher scheme. Today we are witnessing the scanning of the 3-millionth voucher.

Training and Promotion

Initial training is conducted by WV/CARE at the Clinic level to ensure that clinic staff is familiar with the voucher disbursement system and procedures. Ongoing onsite training is also done by the MEDA regional teams to the clinic staff whenever problems are identified. Training also is provided to the Council Health Management Team (CHMT), which is an opportunity for them to become familiarized with whole process.

Promotions are conducted in conjunction with local cultural groups to sensitize communities to proper malaria prevention measures. Advertisements are also done through local media.  

Voucher cycle

MEDA sends the vouchers to the DMO's office, and the DMO subsequently distributes the vouchers to the clinics through the existing system for distributing health-related products. At the RCH clinic, pregnant women and mothers of the infants are issued with vouchers on their first antenatal attendance or on infant's ninth month visit to the clinic during measles vaccination.

Recipients then take the voucher to the designated retailer, where upon paying the small top amount, they exchange the voucher for the net. From this stage, the voucher is exchanged with an ITN from retailer to wholesaler to manufacturers.

Manufacturers then return the vouchers to MEDA, where they receive their reimbursement equivalent to number of vouchers submitted.

The MEDA Voucher Room

Upon receiving the vouchers at MEDA, they are forwarded to the voucher tracking system (VTS) unit, where they are scanned. The scanning system has had to keep up with the growth of the program. It is currently run on three computers. Two computers run the actual scanning process and store double-sided image files of the scanned vouchers, while the third computer holds the transaction database and keeps a record of the status of each voucher. The database keeps track of each voucher through a unique serial number and updates the status of the voucher to reflect its position in the distribution cycle.