In modern development economics two different schools are dominating the discussions. One is lead by the famous almost superstar-like economist Jeffrey D. Sachs who advocates that a “Big Push” is needed – with massive investments on all levels of society. He is the man behind the “Millennium Villages” and author of the famous book “The End of Poverty”. The other school is lead by William Easterly who in opposition to Dr. Sachs don’t believe in the big push – but advocates that what is needed is not one big program, but many small specially designed programs each identifying the problems on a local community level a.k.a the “piecemeal approach”.
There might be some truth to both theories but from our work with mosquito nets here in The Malen Chiefdom I personally more and more lean towards the second. No two situations (or villages, or countries) are similar, and thus different solutions have to be implemented in each case.
Malaria is a massive burden to society (some studies suggest an annual GDP growth penalty of up to 1.3%) so combating it should be obvious and one ought to believe that it would be the priority for everyone living in an effected area to sleep under a net. At least that’s what you think if you’re a white man from a developed country. But the reality is not so obvious. Nets are by no means comfortable to sleep under. Every single night you have to make an effort to tuck it under the mattress, the net prevents air circulation often making it steaming hot to sleep under, and there are many stigmas to the feeling of “sleeping in a cage”. In general all this means that distributing mosquito nets to people who haven’t already themselves identified malaria as a problem is very difficult. This phenomenon is often observed around the world when investigations are done on the usage rates of mosquito nets, even in areas where they are handed out for free. If people from the first place don’t identify Malaria as a problem, then the donor have to first convince the recipients that A: malaria is a big problem to them and B: by they way, we white men from abroad have the solution – you just have to sleep in a cage every night.
In GMin we do things differently. We follow the piecemeal approach and find a solution to a problem the inhabitants of the Malen chiefdom themselves had already identified. They told us how sick they got from malaria but that they couldn’t afford the nets. We helped them find a solution – get them nets. We see this in our daily work as we walk around and distribute the nets. Many families already have some sort of net. The nets they do have however are often very old, torn, or simply made out of regular linen – they are therefore very grateful to receive brand new insecticide treated nets.
One interesting and very important observation we’ve made this year is that if a family doesn’t have enough nets to cover the entire family the parents are the ones who gets covered first. This crucial and helps explain where many other net giving organizations might go wrong.
When it comes to malaria the people at biggest risk are the children under 5 since their immune systems are not yet as developed as older children or grownups. This can be seen in the high number of child mortality caused either directly or indirectly by malaria. For this reason many organizations hand out free nets with the aim of covering children under the age of 5. They give out free nets to pregnant mothers when they come to the health clinic, or at the child’s first immunization session. Since many organizations have as their aim to cover children under 5 only, a problem arises since the donor-recipient incentives are disaligned. The donors want to cover children under 5 and the recipients want to cover grownups and youths.
We are still unsure exactly why there seems to be a bias towards the grownups in terms of household mosquito net usage, but I assume it has something to do with culture-economic household decisions. A child above the age of 5(or a grown up) have already survived the critical age and is therefore more important to keep healthy and alive than the under 5s. I assume the thinking goes that a child under 5 can’t bring food on his family’s table, but a grownup man can –which means he is more important for the family. But yet again, these are only my speculations and not by any means facts.
What we in GMin do to overcome this hurdle is to hand out mosquito nets to everyone. In this way we ensure that even the kids, (who are most vulnerable to malaria) also sleep under a net every single night. This approach has proven to work extremely well here. We managed to find a way to both protect the children (our primary aim) and protect the grownups (the recipients primary aim) and are thus effectively building a bridge that align the donor-recipient incentives.
It might be so that in other countries, regions or chiefdoms the culture is different and the children would be covered first –in such case an under 5 distribution would perhaps work. But the bottom line is that each region is different and that the problems have to be identified individually in order to find the solution that fits best in each case. We couldn’t have planned or imagined these findings from an office in Boston, Copenhagen or Vancouver. Which is why local contact and field work is so important. Another aspect we do in GMin.