Universal
Bed Net Coverage is currently the predominate strategy of eliminating malaria
in the developing world. Yes,
eliminating malaria without a vaccine is (technically) possible. How?
Malaria is transmitted by mosquitos, but an individual acquires the
disease when he/she is bitten by a mosquito that has bitten someone who already
has the malaria parasite in their blood.
While this may seem statistically improbable, when multiplied by the
number of mosquitos on a given night in Burkina (millions) and the number of
people who have some form of malaria in a 15km radius, it becomes much more
likely. However, studies have shown that if 70-80% of the individuals in said
15km radius are malaria free and sleep under (properly used) mosquito nets, the
risk of acquiring malaria is reduced to almost zero. Therefore, if multiple villages can
accomplish 70-80% bed net coverage creating overlapping 15km radii, malaria can
be conceivably “eliminated” from a country
Universal
Bed Net Coverage is the guiding principle behind the strategy of Bed Net
Distributions. In other words, the
powers at be give away mosquito nets for free with the hope that once in
possession of a mosquito net, people will use them on a consistent basis.
Clearly this is a big IF, as there are a multitude of reasons why villagers don’t
use mosquito nets. The mosquito nets
themselves are donated by a coalition of foreign aid organizations such as
USAID and PLAN.
The
last countrywide mosquito net distribution In Burkina Faso took place in 2010,
and because mosquito nets are supposed to last for 3 years, another
distribution was scheduled for June 2013. As I’ve discussed in earlier posts,
the logistics of said distribution were a mess, but in true Burkina fashion,
everything turned out alright. The distribution began with a survey of the
villages in the zone of my health clinic, conducted by Community Health Agents
over a 5 day period at the end of June.
Villagers were given tickets to claim mosquito nets at the distribution,
which didn’t occur until over a month later.
To my surprise, only 3 tickets were lost out of the 600 or so that were
distributed: irrefutable proof that Burkinabe are capable of taking care of
things if they perceive them as valuable.
The mosquito nets were distributed over a 3 day period at the health
clinic, forcing inhabitants of the two satellite villages to travel 15km to
claim their nets.
 |
| Claim Ticket for Mosquito Nets |
 |
| Mosquito Net Demonstration |
 |
| Line to claim free mosquito nets |
The
distribution itself went smoothly, but there was one big problem. There weren’t enough mosquito nets. The World Health Organization recommends at a
minimum one mosquito net for every two people in a family. After the survey information was submitted,
Burkinabe authorities realized they didn’t have enough mosquito nets to fulfill
that minimum requirement. The
solution? Give less to everyone. Those
who needed 1 or 2 nets were given the nets they had been promised. The households that needed more mosquito nets
were simply given less. Those who needed 3 got 2. Those who needed 4 got 3. Those who needed 6 got 5. Essentially, the distribution was conducted
with the knowledge that certain members of households across the country would
not have a mosquito net to sleep under. That
was a pretty frustrating principle to operate under.
Theoretically,
a mosquito net distribution is a great idea, but there’s a dilemma inherent to this
public health strategy. Anyone who’s
been to Costco has experienced a similar dilemma. Contrary to popular belief, most Americans
under the age of 21 do not go to Costco to buy food in absurdly large
quantities or to enjoy the beautiful industrial decorations of the store. They go for the free food samples. There seems to be a never ending supply of
frozen goodies, chips, and other snacks available in tiny servings at random
tables in the food section. These free
samples are supposed to encourage people to buy the product being offered. However, giving away a product for free also
decreases the chances that a customer will ever spend money on the product. Simply put, a customer won’t buy a product if
they think they can get it for free. A
customer also won’t value the product as highly (if at all) when it’s free.
Such
is the case with free mosquito nets.
Burkinabe are never going to spend money on mosquito nets if they know
that every 3 years they’re going to get a certain amount for free. Which brings us to one of the many issues
with not distributing enough mosquito nets: people will not buy more to make up
for the difference in nets distributed and nets needed. Compounded with the other challenges to
convincing Burkinabe to sleep under mosquito nets (outlined in an earlier
post), the strategy of “universal bed net coverage” is highly unlikely to
succeed even if the minimum number of nets is distributed.
Anywho,
now that I know for a fact that community members own mosquito nets, my job
will be to assist with follow up and hopefully convince people to actually use
the free nets.
In
other news, my vacation to Cape Town was f***ing phenomenal (thanks Mom and
Dad!). More to come on my trip in my
next post.
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