The Social Marketing of Insecticide-Treated Nets (ITNs) in Kenya

This 20-page paper explores the work of Population Services International (PSI) to use social marketing in Kenya to promote insecticide treated nets (ITNs) as a way to prevent malaria. Communications were considered an important part of the strategy, complementing distribution. The report explains how the promotion strategy initiated in 1998 was changed in 2003, based on lessons learned.

According to the report, the goal of social marketing is to promote healthy behaviour among low-income and underserved people in order to increase their standard of living and quality of life. Social marketing utilises a variety of private sector practices, such as: 1) commercial distribution of branded health products and services; 2) mass media; and 3) a range of behaviour change communications (BCC) techniques to achieve this goal. PSI’s ITN work in Kenya began in 1998. The approach involved a three-pronged strategy for the first two years:

• aggressive commercial-sector distribution to widen the availability of nets in urban and rural shops and supermarkets;
• increased affordability of nets through a two tier subsidy, with a higher subsidy in rural areas; and
• increasing demand for nets through an intensive national communication campaign.

The objectives of the communications strategy were to increase demand and consumer willingness to pay for ITNs and treatment kits by:

• increasing awareness among parents with young children and pregnant women that ITNs are the most effective protection;
• increasing knowledge about the importance of treating nets with insecticide; and
• increasing consumer awareness of which household members are most vulnerable to malaria (pregnant women and children under five years) for preferential access to nets.

A branded campaign was developed to stimulate demand for Supanet and Power Tab ITNs through radio, television, and print media. Supanet advertising was designed for pregnant women and parents of children under five with soft, family-oriented messages promoting the use of Supanet for malaria prevention. Power Tab communications were designed for all mosquito net owners, and revolved around a locally developed super action hero called “Mr. Power Tab” who runs around smashing mosquitoes and protecting users from malaria. The idea was based on the World Wrestling Federation concept, which is quite popular in Kenya.

The generic communications strategy involved a “shock” campaign intended to spur people into action against malaria. Project research had shown that people are fairly apathetic and fatalistic about malaria, considering it just a part of life. The research also revealed that most people are not aware that pregnant women and very young children are most at risk from malaria. Rather, most believe that everyone is equally at risk. The TV spots, radio, and print messages thus depicted the worst case scenario, warning people that malaria could kill their unborn child or their young children, and emphasising that the way to prevent this was to sleep under an insecticide-treated mosquito net.

The report explains that PSI had promised donors 42% household ownership of nets, 40% of children under five and 30% of pregnant women sleeping under nets, including both rural and urban coverage, by 2006. By 2003, the project goal for urban areas had been achieved, but rural coverage was well below target. At the 2003 rate of rural sales (approximately 200,000), it would have taken several years beyond the project end date to reach a rural target of 42% of households owning nets. According to the report, a shift in strategy involving distribution, pricing and/or communications was urgently needed if the rural coverage targets were to be met by the end of project.

Results on the generic communications campaign media showed poor recall from the “shock and fear” campaign, suggesting that the messages in this campaign were too negative and disjointed. These were spots for increasing awareness about pregnant women and children under five as the most at risk, as well as ads promoting retreatment. All of these disparate messages were aired at the same time.

The new communications strategy incorporated the generic messages under an umbrella “brand” called “Malaria Ishindwe!” (translated as “Down with Malaria!”). The branded slogan was developed through local research. “Ishindwe” is a word often used by preachers in the churches to invoke campaigns against evil things or the devil. So the word, according to the research, has positive connotations among consumers and was readily understood and liked as a memorable rallying cry to fight malaria.

There were three messages in this campaign under the umbrella slogan:

• in order to beat malaria, you have to sleep under a treated net;
• you must know the people most at risk (pregnant women and children under five); and
• you must re-treat your net in order to keep your home a “malaria free zone.”

These messages were disseminated through mass media and interpersonal communications (clinic programmes, community drama groups, road shows, etc.), almost as a religious crusade. The messages were aired in three phases of three months each to insure that each message was understood and remembered by the audience.

The media research subsequently showed very high recall of the campaign and the campaign messages, much higher than the average recall for similar length ads.