Africa Works

The New York Times published a fascinating story about the debate in the humanitarian community over how best to distribute bed nets — treated with insecticide. The bed nets are crucial to impeding malaria, and their use has been rising dramatically in sub-Saharan Africa in recent years, albeit from a low-base. The Times article, co-written by tireless-malaria-watcher Donald McNeil Jr., reports that advocates of free nets have won out, and that net distribution through “social marketing” schemes — in which recipients pay a discounted price — is on the decline. The debate — free versus subsidized — obscures the underlying issue of the importance of Africans using bed nets and why usage is relatively low in the region. One thing the article makes clear — and no one disputes — is that bed nets work to reduce malaria. In my recent trip to East Africa, I spent a month of nights under a bed net and never received a single nocturnal bite (all right, maybe one) even though the heavy rains during my visit meant excellent breeding conditions for mosquitos. The case of bed nights represents an instance of a wider issue in Africa: mental attitudes towards preventative actions. The failure of bed nets to spread in Africa isn’t merely a question of poverty: even well-off people avoided using them until fairly recently, when anti-malaria campaigners raised the profile of bed net use. In this regard, social marketers may be at least partly right. Even if bed nights are given away free, mobilization campaigns — using media, village meetings and demonstrations by leaders and role models — are important to raise adoption rates.