We are sometimes asked whether nets are, or should be, recycled when new nets are distributed or reach the end of their working life. We asked Jo Lines, at the World Health Organisation, who is leads research this area.

Jo's summary advice is: "Don't do it."

The reasons he cites are, and we quote:

"First, there is no evidence there is a pressing need to do it.

Second, when people stop using a net for sleeping, they normally put the net to a lot of other uses.

Third, and perhaps the most important point: these are not our nets, and there are legal and ethical limits to our right to take them away.

Also, if you try to give new nets only to families where the old ones are gone or in bad condition, and not to the families where the nets are still in good condition, you are creating a strong and perverse incentive for people to hide, damage or destroy nets when the project staff are approaching."

The full email from Jo is reproduced below.

Our view is that recycling of nets is very likely to happen but achieving this is not simple. The obvious benefit of the nets protecting people from malaria leaves us all with the clear choice that, even absent of net recycling, it is worth distributing nets.

Jo's email: 

"We do have a couple of people in our team working on this and we are completing a SAICM and World Bank-supported three-country research project on it, with the help of an excellent team of consultants. There is also a long mailing list with a wide range of interested stakeholders - anyone who wants to join it should email Stephanie [guillaneuxs@who.int] or Aurelie [bottelina@who.int]. Many of the key questions cannot be given definitive answers until this research has been completed, but we do have some tentative and subject-to-revision observations and advice to offer in the meantime. 

Our interim advice is : "don't do it".

First there's no evidence for a pressing need to do it: although the total amount of plastic in all those nets sounds large, it represents about 1% of the total plastic entering the region, according to industry estimates. There are concerns that worn out nets might block the use of new ones, but these remain unsupported by solid evidence. The point is: not all old nets are useless. We do have evidence that when a new net is given to net-owning families, the new one is sometimes stored for later use, but this could be because the old net is still working, and we have no evidence to contradict that hypothesis.

Second, we know that when people stop using a net for sleeping, they normally put the old net to a lot of other uses.... OK fishing is not a good idea, but the other purposes - as padding under the sleeping mat, a room divider, a door curtain, crop protection, fencing for the chicken coop - are probably not at all risky, and probably do have significant benefits. These are extremely poor families, so if we want to take something useful away from them, we should have a very good reason... and that reason has not yet been established.

Third, and perhaps the most important point : these are not our nets, and there are legal and ethical limits to our right to take them away. We gave them away freely, with no contract agreed or implied. We can offer to take them away from householders who voluntarily want to get rid of them, but it would probably not be ethical to put them under any pressure. In particular, it is probably not good practice to make the gift of a new net conditional on the surrender of an old one; this would be legal, but it would penalise people whose net was lost for legitimate accidental reasons, and lead to a gradual decline in overall coverage.

It probably IS a good idea to think of whether it would be possible to set up plastic recycling mechanisms, but such schemes should probably be voluntary (or commercial), not compulsory, and should probably embrace a wide range of plastics, not just old nets.

Finally, a note on the coverage gaps that can be caused when campaign nets wear out more quickly than expected. Some programmes have responded to these gaps by carrying out repeat campaigns after an interval of much less than 3 years since a previous campaign. This may be necessary as an interim response, but there is a long-term solution that is expected to be more effective. First, we must recognise that the lifespan of nets in a cohort has a very wide range, with some disappearing very quickly and some remaining functional for more than 4 or 5 years . For this reason, there are inevitable limitations on the capacity of repeated campaigns to maintain full coverage without waste. If you try to give new nets only to families where the old ones are gone or in bad condition, and not to the families where the nets are still in good condition, you are creating a strong and perverse incentive for people to hide, damage or destroy nets when the project staff are approaching. There are rumours that this is exactly what happened in parts of West Africa. If you give nets to everyone, then timing is never good: repeating the campaign after a short interval minimises the coverage gap but is wasteful; repeating it later is less wasteful but leaves a long period when many people are unprotected. Hence our advice is to deliver nets for free to ALL pregnant women and all infants attending EPI. This rate of continuous input will replace a large proportion of the nets that are lost, and greatly reduce the size of the coverage gap. WHO recommendation is that this kind of distribution through routine services should be equal priority to campaigns. As in immunisation, we must plan that in places where there has so far been no routine LLIN distribution, "the catch-up campaign must be Day One of the routine keep-up service".

Hope this helps

Jo" 

Whilst the nets we fund are important, as each net protects two people, catalyzing further action is equally important.

For example, a lot of progress has been made in Phalombe District. Concern Universal has just completed a distribution of 20,000 nets in Phalombe District, Malawi and the following information has just been received with exceptionally good news about further nets from a government stock of nets that, by all accounts, had remained undistributed for some months. The initial distribution of Against Malaria nets has catalysed further distributions using the same standards and methodolgy established by our distribution. 

A quote from Concern Universal  (pdf 259.20 kb)

Malaria is not an equal-opportunity disease. Children under the age of 5 and pregnant women are significantly more likely to contract malaria, so these vulnerable groups require special attention. To save lives most effectively, our combined efforts must ensure that children and pregnant women receive, understand and use crucial bednets.

According to a recent WHO study,34% of households in malaria-prone regions owned an insecticide-treated net, but only 23% of children under 5 years, and only 27% of pregnant women, slept under one. That discrepancy is immensely concerning. If the international community hopes to achieve the 2015 Millenium Development goals for child and maternal health, these vulnerable groups need to be our priority.

Thankfully, our distribution partners recognize this. Save the Children recently distributed 20,000 nets in Malawi using a method that prioritized households with the greatest number of children under 5. Concern universal targeted 15,000 pregnant women with its Phalombe Malaria Communities Project in Malawi. Be sure to check out these organizations' distribution proposals as well as the proposals from other non-profits. We make sure that every proposal from every partner is available online so that you know exactly where your money is going.

As part of a distribution of long-lasting insecticidal nets we require a post-distribution report. These reports should describe all the stages of the distribution and be completed within a few weeks of the distribution being carried out.

We have just had two fantastic examples of such reports detailing the preparation and planning that is the basis for a successful distribution and the challenges and lessons learnt in carrying it out. The first is from Global Minimum for a distribution of 10,560 nets in Sierra Leone in August and the second is from Concern Universal who distributed 9,600 nets in Malawi last month. Both distributions have been carried out extremely competently.

You can see both of these 'immediate reports' by following the links above.

At the time of the Haiti earthquake in January 2010 the immediate need was for rescue teams, medical aid, water, food and shelter. The relevant authorities assured us there would also be a need for nets in the medium term.

That time has now come and 20,000 nets have just arrived in Haiti. Our distribution partner, Partners In Health, have picked up the nets and they will shortly be given out in 14 communities across Port au Prince, the Central Plateau and the Artibonite regions where they are required most.

Over the coming months we will be updating the distribution page with more information on the distribution.