Malawi Clinics

Andrew Conte, a young Canadian aid worker, reflects on the challenges of distributing malaria prevention bed nets in Sierra Leone in 2006.  We are very grateful to Andrew for sharing his experience.

In 2006, I mediated the planning, marketing and distribution of one million bed nets in Sierra Leone. Funded by the World Bank and Global Fund, there were enough bed nets supplied to cover nearly 20% of the country`s population and were distributed at no cost to beneficiaries concurrently with a measles immunization campaign targeting children under 5 years.

Where we successful? Did malaria infections decrease because of increased bed net use?

It’s difficult to say.

Prevalence rates for malaria in Sierra Leone did not exist prior to the campaign, nor has any vital population health data on malaria in Sierra Leone been reported since.

Historically, donors conduct follow-up household surveys a few months after bed net distribution occurs - but this data is never made readily available. I had occasion to observe one survey from Niger that reported less than 20% of inventory (2 million bed nets) distributed being retained by households and used as intended.

With global malaria infection rates reported to range from 300 to 500 million annually - the uncertainty of these estimates measured by the W.H.O. is also never reported. And despite our advanced knowledge of the epidemiology of malaria, there is a cloud of apathetic ambiguity that has engulfed present day malaria control and disease management practices.

A young Sierra Leonean with a malaria net

According to a recent article in the Journal of the American Medical Association entitled Global Malaria Control in the 21st Century: A Historic but Fleeting Opportunity (co-authored by Dr. Richard Feachem, former Executive Director of the Global Fund ), one of the latest exemplary successful management practices in malaria control has been bed net distribution campaigns (funded by the Global Fund of course) because of their efficacy in increasing bed net ownership.

In an environment where humanitarian organizations distribute goods for free, what does bed net ownership mean exactly?

How and when was ownership measured from that instant the bed net was handed over to mother and child? - Where coincidentally, the camera was also poised for a donor’s photo opportunity and a self-predicated success story for the fora of international public health.

Does bed net ownership imply proper behaviour change for bed net use in Sub-Saharan Africa, or any usage at all for that matter?

One must remember - the demographics whom these campaigns are targeting reside in rural areas of developing countries with tropical climates where very little technology, infrastructure and educational outlets exist.

The learning and acclimatization that must occur in order for the introduction of bed net technology to have a lasting effect on preventing malaria infection, such as hanging, education, and behaviour change, extends far beyond the term “ownership” - especially when given to beneficiaries for free.

Yet the rhetoric used by UN and Development agencies is common place. They report their (public tax) dollars (donated from Western countries) spent on aid interventions, and units donated to countries on massive scale - purchased from (Western) private suppliers that operate in monopolized markets - all which predicate irrelevant disease outcomes for those children in Sub-Saharan Africa, who are often carried by their mothers to health centers because they are infected by malaria with symptoms undetected, prevention unknown.

It’s time to break this cycle of carelessness.