Insecticide-treated nets (ITNs) remain one of the most effective malaria prevention tools available. But in Nigeria, where the burden of malaria remains exceptionally high, making every net count means ensuring their full protective benefits can be realised — reaching every household, supporting correct and consistent use, and generating evidence that can improve future efforts.
Malaria Consortium, in partnership with Nigeria’s National Malaria Elimination Programme and State Malaria Elimination Programmes, is implementing a large-scale ITN distribution programme across four states. Made possible by a US$62 million grant from Open Philanthropy (now Coefficient Giving), awarded on GiveWell’s recommendation, more than 16 million ITNs will be distributed, which Malaria Consortium estimates will provide protection to over 27 million people across Abia, Borno, the Federal Capital Territory and Kogi states. Borno is the first of the four campaign states to begin implementation and, with more than five million nets to be distributed, represents the largest campaign within the programme.
This is where Malaria Consortium’s expertise in translating major philanthropic investment into holistic, large-scale delivery on the ground comes to the fore. The delivery model is distinctive: nets are distributed door-to-door, with community health workers registering each household and tracking distribution through a digital health platform. This data-driven approach flags implementation issues — such as delivery bottlenecks or underserved areas — in near real time, allowing the programme to adapt as it goes.
Interventions that work
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Delivering nets to households is only half the battle. Growing resistance among malaria-transmitting mosquitoes to pyrethroids, the insecticides traditionally used in ITNs, has reduced the effectiveness of conventional nets in many settings. As a result, newer dual-active ingredient nets, such as pyrethroid-chlorfenapyr ITNs, have been developed. These nets provide significantly greater protection against malaria transmission and strengthen the impact of community-wide malaria prevention efforts.
For this distribution, this means choosing the right net for local mosquito resistance, building a delivery system that could reach tens of millions of people, investing in community engagement and capacity strengthening and committing to years of survey data to guide future decisions and sustainability. Without investment in correct use and net durability, the impact of a campaign can fall away long before it should. How effective the rollout proves to be will depend heavily on whether nets are used properly, and on how long they remain physically intact and effective.
That’s why gathering evidence on these barriers matters — both for this campaign and for the ones that follow. Even the most technically effective intervention will only achieve its potential if there is a viable model for delivery and if national governments, health workers and, most critically, communities are willing and able to adopt and use it.
Malaria Consortium is working through existing state and community structures to support government-led implementation and promote the long-term sustainability of malaria prevention efforts. A key component of the campaign is engaging with community leaders, religious institutions, women’s groups and other stakeholders to build awareness, encourage participation and address practical barriers, misconceptions and the misuse of insecticide-treated nets. The aim is to sustain this community engagement in the long term to encourage a sense of ownership in eliminating malaria from their own communities.
The broader campaign across the four states includes multiple rounds of household surveys: at baseline, immediately after distribution, and then annual surveys at one, two and three years post-distribution. These will track net access and use, retention and attrition, physical durability and the factors influencing how well ITNs are maintained and remain in service over time.
Understanding the barriers to impact
A separate GiveWell-directed grant investigated why access might not always translate into consistent use for all households. The Be In A Net project — a collaboration between Malaria Consortium and the Behavioural Insights Team — specifically explored the practical and behavioural barriers to consistent net use in Nigeria and Uganda, and tested whether low-cost, locally informed approaches could help address them.
To understand these barriers deeply enough to design effective solutions, an evidence-based behavioural approach grounded in peoples’ lived experience was developed. It began with reviewing 124 previous studies from across these regions to understand what prevents, encourages and improves use of nets. Supplementary primary research that included speaking directly with residents across Uganda and Nigeria in their homes and conducting household observations, interviews and focus groups was also undertaken. The project then developed 16 potential interventions, with Nigeria and Uganda’s Ministries of Health narrowing to two which were prototyped with around 200 community members.
The first offered soft, coloured nets by default in place of the standard harder white ones, paired with messaging framing them as widely liked and preferred locally. The second, a Net Champion programme, had households signal nightly net use with a sticker and rewarded sustained use with a small gift and public recognition, turning a private habit into a source of social pride. Both interventions require minimal resources, and the low costs associated with each one make them highly promising, complementary approaches.
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Making effective interventions more effective
Investments in programmes that build on previous learning can generate greater impact than funding interventions in isolation. By combining delivery at scale with evidence on how people engage with and use the intervention in practice, we can identify where impact is being lost, refine the model and direct future resources towards the approaches most likely to work. This creates a continuous cycle of implementation, measurement and adaptation, helping ensure that what is taken to scale is not simply proven in principle, but optimised for effectiveness in context-specific, real-world settings.
Effective giving is sometimes framed as a single choice: fund the intervention with the best evidence behind it. This programme shows why it’s only the starting point. Getting the most out of large-scale philanthropic investment is built on a cascade of decisions — and the answers from this campaign will shape similar work in years to come.
