Insecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist. To address the gap in continuous distribution cost data, four types of delivery systems—CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)—were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys. Overall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37–4.61 USD, CD channels: 3.56–9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34–4.55 USD, Ghana and Tanzania 2017 school-based: 3.30–3.69 USD, health facility-based: 3.90–4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions. These results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.

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撒哈拉以南非洲经杀虫剂处理的蚊帐分配系统的成本

杀虫剂处理过的蚊帐是预防疟疾的最具成本效益的措施之一。世界卫生组织建议进行大规模的大规模分发运动和连续分发（CD），这是实现和维持普遍使用ITN的多方面战略的一部分。这些策略的组合对于扩大ITN访问有效。为了使决策者能够就如何有效实施CD或组合策略做出明智的决策，关于这些交付系统的成本和成本效益的信息是必要的，但是关于成本连续分配系统的已发表研究相对较少。为了解决持续分销成本数据中的缺口，提供了四种类型的交付系统，即通过产前护理服务（ANC）的CD和扩大的免疫计划（EPI）（加纳，马里，和坦桑尼亚大陆），通过学校（加纳和坦桑尼亚大陆）的CD，以及基于社区/医疗机构的联合分销（坦桑尼亚的桑给巴尔）和大规模分销（马里），都需要付费。有关成本的数据是从财务和运营记录，利益相关者访谈以及资源使用调查中追溯收集的。总体而言，从提供者的角度来看，大规模分销和连续系统交付的ITN的经济成本是每网分配的重叠经济成本（质量分配：4.37–4.61美元，CD渠道：3.56–9.90美元），其中两个是基于学校的系统，质量分布在此范围的下限。从国际捐助者的角度来看，裁谈会系统的成本在很大程度上比大规模分配的成本要低（质量分配：4.34-4.55美元，加纳和坦桑尼亚，2017年基于学校的费用：3.30-1.39美元，基于医疗机构的费用：3.90-4.55美元，结合社区/医疗机构的费用4.55美元）。坦桑尼亚2015年基于学校的分配（7.30美元）和2016年基于医疗设施的分配（6.52美元）例外。大规模分发由捐助者提供更多资金，而裁谈会更广泛地依赖国内资源捐款。这些结果表明，特别是从捐助者的角度来看，裁谈会的战略可以继续以可比质量分配的成本交付网。大规模分发由捐助者提供更多资金，而裁谈会更广泛地依赖国内资源捐款。这些结果表明，CD策略可以继续以与质量分配相当的成本交付网，尤其是从捐赠者的角度来看。大规模分发由捐助者提供更多资金，而裁谈会更广泛地依赖国内资源捐款。这些结果表明，特别是从捐助者的角度来看，裁谈会的战略可以继续以可比质量分配的成本交付网。