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Date: 2024-05-18 Page is: DBtxt003.php txt00009096

Health ... Malaria
Dialog about Nets



Peter Burgess


Jeffrey Gettlemen’s recent New York Times article “Meant to Keep Malaria Out, Mosquito Nets Are Used to Haul Fish In” brings a concerning situation to light. Long-lasting Insecticide Treated Mosquito Nets (LLINs), when misused, may be undermining fragile African fisheries, or worse.

If we care about fishermen’s livelihoods, we ought to ban nets, right?

Let’s consider some facts about malaria.

LLINs are one of the most effective tools for malaria prevention today. Since 2000 an estimated 4.3 million lives have been saved–and 670 million malaria cases prevented– as a result of a global scale-up in malaria interventions, including the distribution of LLINs, indoor spraying, treatment with effective anti-malarials, and more. Nets are inexpensive, easy to use and effective. Inevitably, some of the hundreds of millions of nets distributed over the past decade have gone for unintended purposes – fishing nets, wedding veils, packing materials, etc. But clearly, many if not most of them have been used as intended: killing mosquitos that carry malaria and whose nighttime bite would otherwise sicken or kill a child under five.

PSI is a major distributor of LLINs in Africa. As William Easterly’s 2006 book White Man’s Burden pointed out, we used to sell them, at a highly subsidized price. But when evidence became clear that any price was too much for the poor rural households that died most from malaria, we joined the global health consensus and began distributing them for free. The Global Fund for AIDS, TB and Malaria, and the U.S. President’s Malaria Initiative have led this consensus. We’re proud to be a part of their success in reducing mortality.

Mr. Gettlemen is right to highlight the need for continued behavior change efforts with LLIN recipients. It’s not enough to hand the nets out; getting them hung in households and ensuring they are protecting the most vulnerable within — kids and pregnant women — is a marketing challenge greater than any price setting exercise.

What are the other social investments in the poor areas Mr. Gettlemen wrote about? Are there agriculture programs teaching fisherman about sustainable fishing practices? Are there food aid projects teaching families how to expand their subsistence farming or giving them fortified food? Do women have access to and education about family planning so they can have the family sizes they desire? Do micro-financing opportunities exist to help fisherman buy the more expensive nets?

Even when all these interventions exist, it’s rare that they are coordinated or integrated.

The real problem Mr. Gettlemen’s article brings to light is not that people are using LLINs to fish. It’s that they have to.

Health and the environment are inextricably linked. Poverty and education go hand-in-hand. Yet few foreign aid programs reflect that reality on the ground.

PSI’s next issue of Impact Magazine focuses on innovation and in it we will unpack some of the roadblocks that exist in international development today, including the rigidity of our siloed funding and donors’ foreign aid budget lines. We’ll explore some of the challenges we face, but also the many solutions we have at our fingertips.

Nets, along with effective malaria treatment, targeted indoor household spraying, and other protective measures are responsible for saving millions of African lives. Yes, we need to figure out how to keep doing that while not imperiling fisheries too. But let’s not throw the nets out with the fish water.

Photo: Florence Tibiita and her child with an LLIN over her bed. (Credit: Trevor Snapp)

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