Charity vs. Capitalism in Africa

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Sustaining Manufacture and Use

"We've built up a system that gets people to appreciate and buy and look after [bed nets]," says Jane Miller, director of malaria initiatives for Population Services International Tanzania, a unit of a Washington nonprofit, Population Services International, which harnesses social marketing techniques to improve health care in emerging economies.

Unlike mass distribution programs, social marketing schemes have to be economically feasible. Though profits for the providers are often slim to nonexistent, the systems established to get socially beneficial products from the factory to the field may be more cost-efficient in the long run—and can create sustained jobs and earnings for locals involved in the supply chain. Indeed, distributing free nets could even undermine the nascent business ecosystems that have sprung up to manufacture and distribute bed nets.

PSI and Tanzania-based Ifakara Health Research & Development Center are among the groups that have built distribution networks in Africa for insecticide-treated nets, including retail agents in villages and wholesalers at a regional level. To be sure, the agencies welcome the recent surge of interest in malaria from governments and private donors. But they worry about creating a sustainable system for disseminating nets once the topic has fallen off the front page.

"We're trying to think more clearly about [what happens] after the donor money runs out," says PSI's Miller. "At the moment, the donors seem to saying that money is no object. But it certainly will be in the future."

Miller also is concerned that the mass distribution campaign advocated by Sachs could undercut the commercial sector for nets that has slowly developed in Tanzania. Consider Asif Ladak, a wholesaler of nets in the Tanzanian capital of Dar es Salaam. Ladak is concerned he will lose clients if Sach's free distribution plan is deployed.

A Mixed Approach

The ideal solution looks to be a combination of both free distribution and social marketing. "We think there will be opportunities for complementary public free distribution and stimulation of private channels," says Brian Trelstad, chief investment officer for the New York-based Acumen Fund, a nonprofit global venture fund that uses entrepreneurial approaches to solve global poverty. "People will need to have access to nets even when the wave of free distribution ends."

Trelstad says research by Pascaline Dupas of Dartmouth College and the Poverty Action Lab at MIT shows that bed nets would sell in greater volumes if they cost $1.50 or less—below prices that now range up to $3.50. And he thinks private distribution must remain an option because public institutions may not be able to blanket the countries that need nets at quite the rate that Sachs and others would like. "They're focused on admirable resources and goals, but there will be accountability issues for them as well," Trelstad says.

Sachs concedes that not all the nets he plans to distribute will reach the hands of the needy. "Will it be perfect? No," he says. "But this is one of the easiest problems I'm trying to solve. It's easy to distribute nets and there's high public awareness of how to use them." For the sake of Africa's population, let's hope that in this case everybody is correct.

Eliza Barclay is a freelance correspondent who traveled to Tanzania as a fellow with the International Reporting Project of the Johns Hopkins School of Advanced International Studies .