The dignity of malaria victims

Chris D. Gingrich, an Eastern Mennonite University economics professor, stands in front of a typical store in Tanzania’s program to distribute malaria nets using vouchers-for-discounts supplied by Mennonite Economic Development Associates. Gingrich believes the voucher system helps boost Tanzania’s economy of small business owners. — Photo providedBy Bonnie Price Lofton, Eastern Mennonite University

As printed in the July 11 issue of Mennonite Weekly Review

HARRISONBURG, Va. — An Eastern Mennonite University economics professor is a major player in a debate among malaria experts regarding the best way to reduce incidences of the disease.

Chris D. Gingrich, who teaches in EMU’s business and economics department, says everyone agrees malaria is the largest health problem in sub-Saharan Africa.The disease causes 300 million to 500 million clinical episodes per year and claims more than 1.5 million lives, including more children under age 5 than any other illness.

Gingrich says everyone also agrees that insecticide-treated nets, or ITNs, are the most cost-effective defense against malaria yet developed.

But experts diverge on how to get ITNs distributed and put to use widely and quickly.

Jeffrey Sachs, a famous economist and public health advocate affiliated with Columbia University, has been campaigning for an expenditure of $3 billion per year to fund the free distribution of enough ITNs to cover every person every night in Africa, reported the Oct. 26, 2007, issue of Science. (The species of mos-quito that spreads malaria feeds mostly between 11 p.m. and 4 a.m.)

Sachs’ free-nets-for-all approach has been backed by certain public policy researchers and epidemiologists at some of the best-known institutes in the world, including the Harvard School of Public Health.

Gingrich and his three colleagues — two based in Great Britain and one in Tanzania — are less certain that free net distribution is the best long-term, most sustainable solution for developing countries. They are among the first to collect and present evidence regarding the economics of ITN delivery.

In their latest article, published in Social Science & Medicine in June, the Gingrich team reported that a nationwide voucher system used in Tanzania, whereby consumers pay a fraction of the cost of a mosquito net, had caused net purchases to increase from 18 to 62 percent among targeted households.

Here’s how the voucher scheme has worked in Tanzania since 2005.

When pregnant women go for prenatal checkups, offered free under the government-supported health system, they get a voucher supplied by Mennonite Economic Development Associates. Similarly, caregivers of infants receive a voucher at the time of a child’s measles vaccine. In 2010, this voucher covered 90 percent of the cost of buying an ITN.

The women can take this voucher to any participating retailer — usually a small local shop owned by someone who supplies them with the basics, like soap, sugar and batteries. And until recently the women could choose the net they prefer. They then hand over their voucher and walk away with a net that retails for maybe $5, for as little as 50 cents out of their pockets.

Pregnant women and infants are targeted for the Tanzanian voucher program, Gingrich said, because they are more likely to die from an episode of malaria than are non-pregnant women, older children and men.

Gingrich, who has traveled to Tanzania three times for his research, believes consumers are more likely to value and use an ITN if allowed the dignity of being able to make their own choice.

However, recent changes in the program include supplementary distribution of free nets and a move toward uniform net size, color and design.

“I don’t want to be told what kind of car to drive, and I believe women [in Tanzania] don’t want to be told what kind of net they get to have,” Gingrich said.

“When donors conduct large-scale distribution of free nets, it is true that nets will reach more people very quickly, but I am not convinced that they end up being used as intended over the long term. A couple of weeks ago I was in a region where nets had been widely distributed for free, and I saw them used for fencing, in vegetable gardens and as soccer goals.”

MEDA supported his malaria net research during a 2007-08 sabbatical from EMU.