Roll Back Malaria: a failing global health challenge: Developing a market for bed nets and insecticides is problematic

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7452.1378-b (Published 03 June 2004) Cite this as: BMJ 2004;328:1378
  1. J Derek Charlwood, honorary fellow (dc{at}bilharziasis.dk)
  1. Danish Bilharziasis Laboratory, Furvela, Mozambique

    EDITOR—As shown in Yamey's recent editorial on the failure of the Roll Back Malaria campaign,1 appropriate economic thinking for sustainable development in Africa continues to be ignored. Thus, the customer for bed nets is not the individual African but the large non-governmental organisation, whose orders are largely based on price, not quality.

    Economic lessons show, however, that markets are developed by the quality of a product. People, even poor Africans, are prepared to pay for quality, and although it is true that not everyone can afford to buy nets, once a critical mass of users of impregnated nets has been established then non-net users are also protected.

    Rather than insisting on a low price, non-governmental organisations could instead set the manufacturers of nets the more difficult target of producing, say, a permanently impregnated, durable net that works against Culex quinquefasciatus as well as anophelines.

    Similarly, while the arguments rage over the possible reintroduction of dicophane (DDT),2 the Achilles' heel of many past and present indoor residual spraying programmes is people's refusal to have their houses sprayed, irrespective of the insecticide used.

    The World Health Organization (WHO) issues guidelines to malaria control programmes so that workers know when to consider changing treatment as drug resistance increases. Perhaps WHO should do the same for malaria control programmes based on indoor residual spraying in the face of increasing refusal rates. At least DDT, because of its repellent effect, might provide some measure of personal protection to individual householders in the absence of a mass effect due to a high refusal rate among the population as a whole. But whether spraying an ever diminishing number of houses is the appropriate role for a malaria control programme is questionable.


    • Conflict of interests None declared


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