Photo Credit: alisonbird/Flickr.
A key criticism of foreign aid is that donor programs tend to import the commodities needed to support programs, rather than purchasing them locally, which can effectively kill local production industries. This criticism is invoked frequently in the case of food aid and more recently this criticism has been invoked in the case of bed nets for malaria. Most of the nets that have been purchased with donor funds from major global health initiatives have been sourced from producers located outside of the destination country, leaving little opportunity for the development of a local industry to produce these nets. This argument has been discounted by many in the health community that have argued that the lifesaving effects of these nets far outweighs the need to develop a local bed net industry and that health concerns far outweigh economic considerations.
But local production is just part of the story, and I have witnessed another side effects of these strategies, one which could have a more direct effect on health. In addition to production, the effective delivery of bed nets also requires these nets to be imported, distributed, and sold locally. In Ethiopia, prior to massive free bed net distribution programs, there was a local private bed net distribution system. Local businessmen took it upon themselves to import nets into the country and distribute them to retail shops across the country. I’ve seen survey data that suggests that upwards of a quarter of households in some areas purchased bed nets through these private retail distribution channels.
You can probably guess where this is going: Ethiopia won a big project malaria grant and millions of nets were important and distributed free of charge throughout the country, in particular in the areas with high disease burden. The program was perhaps the single largest bed net distribution program ever undertaken anywhere in the world and from what I can tell the nets really did get to those who needed them (what impact they have had on clinical outcomes, is another story which I will leave aside). But, according to people I interviewed, the private distribution channels that existed before this distribution programs suffered major set backs. No one needed to buy a net anymore, so no one did. Importers stopped importing nets, distributors stopped distributing nets, and retailers stopped selling nets. Selling bed nets was no longer good business.
While many more people got a net that perhaps would have ever purchased them in the first place, the problem arises when one considers what will happen over time. Communities were targeted through this grant once and for now there are no plans to return to these communities. In the interim, should a household want to purchase a net, it is now more difficult to do so. The free nets may become less effective over time but it is hard for households to buy replacement nets. The distribution channels that took years to establish have been killed and may never return, in particular if business believes that there is a risk that the public distribution programs will be repeated.
While I don’t think this is necessarily an argument against large scale distribution programs, because I do believe that such programs can achieve higher bed net coverage than leaving it to the free market, I do think it points to how a public-private solution may have avoided some of these problems. Had the donor funds been used to purchase some of the nets from local distributors, using local channels, than the networks might have been saved – even rewarded for their efforts. Saving lives is the priority – no doubt – but sometimes it does not have to be either or – corporate interests are not inconsistent with health interests.
P.S. Since posting this post, Bill Brieger posted a follow-up comment on his website. I thought it was a good follow-up read, so I am linking to it here.Share on Facebook