Friday, August 7, 2009

Good News on Malaria Control

The best price for getting antimosquito bed nets to the poor proves to be “free” BY JEFFREY D. SACHS

A persistent question about sustainable development is how to help the world’s poorest people. Their incomes are so low that they lack access to the most basic goods and services: adequate nutrition, safe drinking water, sanitation and vital health interventions. One strategy is to provide targeted financial support to help the poor to meet their basic needs and thereby to escape from the poverty trap. My colleagues and I have calculated that the cost of ensuring basic lifesaving health coverage for the world’s poor would be around 0.1 percent of gross national product of the high-income countries.

One example of such targeted aid is a mass free distribution of antimalaria bed nets to people living in impoverished malarious regions of Africa. Each of these longlasting insecticide-treated nets (LLINs) costs only about $10 to produce, transport and distribute to households in rural Africa. Because the nets last for five years and two children typically sleep under each net, the cost per child a year is a mere $0.50. Even at this remarkably low cost, however, some critics have opposed such an approach.

They have claimed that free nets would “go missing” in large numbers because of waste by recipients and others in the supply chain who did not properly value them. These critics’ preferred solution is market sales of nets at a discount, on the grounds that even a small price would encourage more efficient use of the nets. Experiments and real life have now provided evidence to resolve this debate convincingly: the case for mass free distribution of bed nets has proved to be stunningly powerful. After many years in which bed-net coverage was extremely low, it is now soaring, and malaria cases are falling sharply where mass bed-net distribution is being deployed.

Here is how events have unfolded. Because Africa’s rural poor are so destitute, attempts to sell them subsidized LLINs from 2000 to 2005 not surprisingly fell badly short, even at prices as low as $2 to $3 per net. The incidence of taking up these bed nets in Africa through sales was very small and covered only a tiny fraction of those in need. In 2002 and 2003 the International Committee of the Red

Cross and UNICEF began experimenting with a mass free distribution of LLINs in some trial sites. Spot checks of the recipient communities a few months later verified that distributed bed nets were indeed in the households in high percentages. As the evidence of success of mass distribution continued to grow, the World Health Organization adopted that strategy as its basic standard in 2007. The international partnership known as Roll Back Malaria set a goal to freely distribute around 300 million LLINs in Africa during the period 2008 to 2010 to cover all sleeping sites in malaria-transmission regions. Already the coverage has jumped from perhaps 10 million LLINs in 2004 to 170 million as of the end of 2008. Recently the Poverty Action Lab at the Massachusetts Institute of Technology carried out a detailed experiment in Western Kenya that compared mass distribution with a partial-subsidy approach: even a small charge for bed nets led to a tremendous drop in their adoption.

Moreover, there was no greater wastage of the nets received for free than for those purchased at the discount price. The study’s conclusion was clear: “Free distribution is both more effective and more cost-effective than cost-sharing.” The Roll Back Malaria Partnership has now embarked on a coordinated effort to ensure comprehensive malaria control throughout Africa that includes not only LLINs but also medicines, rapid diagnostic tests and community health workers trained to deliver such essential interventions. The cost will be around $3 billion a year, or $3 annually for each of the one billion people living in the high-income donor countries. It is time to take the demonstrated successes of mass free distribution for such assistance to full scale.

Source of Information : Scientific American August 2009

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