Uncharitable thinking

Who wouldn't want to help Africans avoid malaria and find sustainable work? Western aid officials, says Nick Petford

April 7, 2011

When it comes to giving to good causes, the British are often ranked among the most generous people in the world. With Comic Relief, the annual nationwide fundraising event, recently concluding with another record-breaking collection, it seems churlish to question the cause to which the money will be put. Among other things, Comic Relief supports efforts to tackle malaria in Africa, but while celebrity-endorsed mosquito bed nets appear to offer a simple and cheap solution to the endemic disease, there are serious questions about their use that cast doubt on their long-term effectiveness and value for money.

Handing out mosquito nets in bulk, free of charge, does not guarantee that recipients will use them. Indeed, research in the Niger Delta in which I was involved finds the opposite.

The high levels of infant mortality caused by malaria certainly need tackling. Although action is being taken through the United Nations Millennium Development Goals, it is now clear that the target of reducing the mortality rate of children under five by two-thirds by 2015 will not be met.

Insecticide-treated nets can provide a highly effective physical and chemical barrier to malarial infection, but only if used correctly. And here lies the problem. Contrary to Western public perception, encouraged in part by the likes of Comic Relief, research published in the Journal of Multidisciplinary Healthcare this month shows that uptake and use of nets among affected populations is a complex process with no guaranteed outcome.

In 2009, I was principal investigator on a two-year British Council-funded project that brought together Bournemouth University, Lagos State University Teaching Hospital and the Niger Delta Youth Development initiative to study the use of mosquito bed nets in the Niger Delta. Although the focus was on health, the project also involved a more radical proposal to field-test a pop-up mosquito net for infants designed to overcome many of the barriers to the effective use of bed nets.

As our work showed, a person given a bed net must hang it from the ceiling (assuming he or she has one). This results in a low take-up for several reasons: difficulty in set-up (people can't be bothered); safety (a net suspended from the ceiling is a fire hazard where naked flame is the primary source of light); heat-trapping effects; and infants' sleeping patterns (until the age of two or three, Nigerian children in rural areas sleep with their breastfeeding mothers).

Nonetheless, many charities and agencies like nets because they can be distributed easily and the numbers handed out can be held up as evidence of success.

When we visited Abuja to discuss the problems we had identified and a potential solution that could not only improve the use of nets but also provide work for locals, the UK officials we met proved uninterested. Our idea fell on deaf ears.

Significant funding is available to fight disease in Africa. Nigeria recently signed a credit agreement with the World Bank for an extra 13 billion naira (£52.7 million) to strengthen its primary healthcare systems. But the country's 2020 vision is also to become a top 50 world economy through more wealth creation and employment. We had hoped that our project could lead to real economic opportunities by developing pop-up net technology in Nigeria. The Delta region has a sewing tradition, so the skills base needed to make the nets already exists. And our project partners have access to specialist companies that produce World Health Organisation-approved long-lasting insecticidal nets.

My experience echoes the plea economist Dambisa Moyo made in her book Dead Aid: Why Aid Is Not Working and How There Is a Better Way for Africa (2009). She calls on the West to change tack and help Africans find sustainable solutions that work for them, not to impose target-driven aid of the sort that counts the effectiveness of malaria reduction by how many nets are distributed.

Our longer-term ambition is for pop-up bed nets to be manufactured locally, creating much-needed employment and more access to capital via a network of local cooperatives through a social enterprise model. But apparently it is much easier to distribute 50,000 nets destined for landfill than to risk doing something that could improve uptake and create wealth.

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