International Recommendations on Universal Coverage

To reduce malaria transmission, the World Health Organization (WHO) recommends that countries aim for universal coverage with insecticide-treated nets (ITNs).[1] WHO recommends that both large-scale mass distribution campaigns and continuous distribution both occur as part of a multi-channel strategy to achieve and maintain universal access to ITNs.1 Continuous distribution occurs within the routine health care system such as ANC clinics and those that provide services under the Expanded Program on Immunization (EPI), and through other distribution points such as schools, community outlets and programs involving the private sector.

In order to achieve Universal Coverage, the whole population must have access to an ITN every night. Factors such as prioritization and sleeping patterns within households will affect access, making true access extremely difficult to measure. The international consensus, however, is that universal access would be achieved if every household had at least one ITN for every two people[2]. The assumption is that this will amount to universal access, as most ITNs will be shared by at least two people. Data from a range of countries show that this is usually the case[3].

The term ‘Universal’ suggests a target of 100% of people sleeping under an ITN every night—the ideal goal. Most countries have set more realistic targets, a little lower than this, most commonly at 80% or 85% of the population having access to an ITN within the household. Ideally, this level should be set no lower than the minimum coverage needed to have an impact on malaria transmission. In reality it is not possible to specify what this coverage level is, as it will be different in different settings. It is assumed that 80% to 85% of people with access to an ITN combined with a high access to use ratio of over 80% will be sufficient to achieve the objectives of Universal Coverage.


[1] WHO (2013) WHO recommendations for achieving universal coverage with long-lasting insecticidal nets in malaria control. Available from: Accessed 26 May, 2015.

[2] Roll Back Malaria (RBM)/ RBM Partnership Monitoring and Evaluation Group (MERG), Survey Indicator Guidance Task Force. Meeting report, 5–6 April 2011, New York, USA.

[3] Kilian A, Wijayanandana N, Ssekitoleeko J. (2009) Review of delivery strategies for insecticide-treated mosquito nets – are we ready for the next phase of malaria control efforts?