Since my original post on the coverage of the so-called 'Net Controversy' in the NYT in which free distribution of LLINs is advocated for and social marketing approaches are declared 'over,' several other responses to it have come to my attention.
April Harding at Global Health Policy writes about the drawbacks of the free giveaway campaigns:
- Campaign giveaways by themselves don't achieve high ownership of ITNs...
- The ownership that is achieved doesn't translate directly into utilization...
- Campaigns rely heavily on effectiveness of government management of donor support...
- Lacking attention to demand, and supply promotion, coverage achieved by giveaway campaigns are dependent on constancy of donor attention and funding; when these wane, so do the campaigns and so does the coverage they've achieved.
...While the emerging drift toward this "feel good" strategy may let the global community pat themselves on their collective backs for achieving large volumes of handouts, it sadly comes at the expense of contributing to sustainable reductions in malaria through less sexy but more effective combination programs.
Mead Over discusses Dr. Arata Kochi's, head of WHO's malaria program, recent decision to expand the use of indoor insecticide spraying as a positive step in advancing the cause of malaria control and contrasts this with his recent 'unfortunate action' on net distribution strategies.
Until public sectors work as well in poor countries as they did in the case of the artificially well-managed research on which Dr. Kochi's conclusions were based, we need to retain social marketing as one of the important ways to distribute bed nets. Furthermore, we hope that Dr. Kochi joins the large community of researchers and malariologists in recognizing that private distribution of ACTs is an essential element of their rollout, and therefore a major justification for the global subsidy for these drugs now being engineered by the international malaria community.
Healthy populations are more likely to become customers than unhealthy ones. Unhealthy societies cannot rise above poverty because they cannot become productive enough to rise above a subsistence level economy. The social marketing experiment may not have worked, but it certainly wasn't a wasted effort. Discovering best practices is always a good thing and that normally means discovering practices that are not so good.
The NYT decided to publish only one letter from a program director in Uganda who also sells nets and points out that education is an important component of an effective net distribution strategy (you can't just throw them off the back of trucks?). The one sent by Population Services International was ignored. So was this one by Chris White who was the previous NGO
representative on the Roll Back Malaria Partnership Board and allowed me to
publish it here.
To the Editor,
How disappointing to read Donald McNeil's negative article on malaria control (Distribution of Nets Splits Malaria Fighters, October 9th). When we are starting to see real progress due to the scaling up of proven interventions, the American public get to read more bad news. Contrary to what your article suggests, there is no 'split' among malaria workers over mosquito net distribution methods. As highlighted in a recent article published in the Lancet, the malaria community stands united. It is now widely acknowledged that rapid and equitable coverage of at-risk populations needs to be achieved through a combination of free mass net distribution campaigns and sustained access approaches, including social marketing. Wouldn't it be nice for the public to hear good news from Africa for a change? Right now, in the malaria business, there's a great deal to be optimistic about. If I were a reporter, I'd be reporting that.
Meanwhile, the Bill and Melinda Gates Foundation this week is convening "...one of the most high-powered groups ever assembled to fight the killer disease." You can catch up on the conversation or keep up by reading Gates Crashing Live Blog.