Bednets and the Demise of Social Marketing - What the NY Times Missed

Submitted by Abigail Keene-B... on October 10, 2007 - 12:29.

The New York Times ran an interesting but rather incomplete article yesterday, discussing the split over anti-malaria bednet distribution strategies in Africa and the apparent demise of “social marketing” as a legitimate approach to reducing illness on a large scale. The article focuses on an ongoing debate in the aid community over whether or not insecticide-treated bednets, produced by Danish and Japanese makers and purchased by aid agencies, should always be given way in mass quantities for free.

Evidence provided in the article points to the failure of “social marketing” techniques (advertising, branding, and selling of essential goods with social value through local distributors, sometimes at heavily subsidized prices) to reduce local, short-term rates of malaria infection as fast as the massive free hand-outs of nets by aid agencies. Senator Tom Coburn (R) Oklahoma was quoted as going so far as to say that, “We knew social marketing doesn’t work."

But let’s take a step back. First, who, in this case, is conducting the “social marketing”? It's the aid industry. What is the aid industry designed to do? Raise, collect, and then deliver charity to those in need.

On the other hand, what are enterprises designed to do? Produce, market and deliver desired goods and services efficiently, so as to be self-sustaining and maximize financial success. Which one has the greatest invested interest in making sure that people will actively seek out its products, and will continue to have access to them, over and over again?

When we remove the marketing from the producers of bednets, incentives to market effectively and to maximize distribution begin to dilute, become inefficient, get lost. And, for all of its very good intentions and valuable contributions to alleviating human suffering, the inefficiencies of the aid industry and its large contractors are well known. It is also well known that the aid industry cannot promise the renewal of massive grants for the same project or purpose.

So, what will happen when malaria is not the hottest issue in aid? What will happen in five years when the nets wear out and need to be replaced? And what happens to those communities that the temporary “armies of workers who are paid a few dollars a day” were unable to reach within the week or two that they were hired to conduct mass handouts?

The article in the Times missed many important points, but instead of an academic discussion of sample sizes, location bias, and selectivity problems, I’d like to direct attention to a for-profit enterprise that could have been an interesting counter-point in the article.

A to Z is a family-owned producer of long-lasting anti-malarial bednets located in Tanzania. Recently, it has received patient capital to expand its production capacity; A to Z now produces 7 million nets a year, and it has become the third largest employer in the country. Its production costs are the same or lower than those of foreign bednet makers. Due to its proximity and familiarity with its target market, transportation costs are much lower and knowledge of the local environment and market dynamics is superior.

A to Z sells some of its nets to development agencies, but the company is also designing and undertaking its own social marketing campaigns and distribution experiments to educate people about the benefits of its product, to make the nets increasingly accessible to the poor in rural areas, and to create a long-term market for the nets.

No doubt, there is and will continue to be a need for life-saving nets to be distributed for free to those who otherwise would have no access. However, to write off the potential of social marketing techniques to help create sustainable mechanisms that produce and deliver basic goods and services is dangerous. It not only condemns businesses that could potentially employ thousands of local workers and offer long-term solutions that will be there when aid money is not, but it permanently paints poor people as objects of charity, without the luxury of choice or the capacity to help themselves.


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Submitted by Omar Yaqub on October 11, 2007 - 10:51.
One more thing… What's important to realize is that putting a net in someone's hand doesn't necessarily translate into a net over someone's bed. What often happens is the net goes under the bed and is forgotten about, it is sold, or it is cut up and used less effectively as window and door coverings. Social marketing helps to ensure that nets are used properly, plus it creates demand for them where it may not have previously existed.
Submitted by Abigail Keene-B... on October 11, 2007 - 11:30.

Very true, Omar. In fact, upon returning from her work with A to Z in Tanzania, Keely Stevenson (Acumen Fund 2006 Fellow) shared many insights about this gap between receiving (or buying) a bednet, and the use of it every single night. Keely's insights about consumer education techniques, social marketing and pricing mechanisms that actually produce social outcomes should be available soon through white paper publications and other resources.

For now, anyone interested in more details can listen to an audio recording of Keely's insights, and those of the other Acumen 2006 Fellows, here.


Submitted by Omar Yaqub on October 11, 2007 - 22:33.
Hello, I think we're both talking along the same lines. I'd be very happy, ecstatic, to help with any social marketing efforts. Please let me know if there is anyway I can help. Cheers, Omar http://omar.yaqub.org
Submitted by Andrew on October 12, 2007 - 16:22.
A ten-year project funded by USAID to prevent malaria by increasing access to and use of ITNs in sub-Saharan Africa, NetMark (www.netmarkafrica.org) addresses the challenges you discuss in three ways: commercial expansion, short term targeted subsidies or market priming activities, and long-term targeted subsidies to vulnerable groups in order to achieve equity. Working to increase demand through messaging, increase supply by working with vendors and distributors, improve technology in collaboration with manufacturers, and reduce obstacles through advocacy, NetMark aims both to develop a sustainable commercial market and to ensure that vulnerable groups have access to affordable ITNs. In addition to increasing the proportion of households that own ITNs, the project also seeks to increase nightly use of treated nets, especially by pregnant women and children under five years of age; and to increase the proportion of net owners who, if not using a long-lasting ITN, regularly treat their nets with insecticide. Managed by the Academy for Educational Development (AED), NetMark has programs in Ethiopia, Ghana, Nigeria, Senegal, and Uganda. its partners include over 40 national and international insecticide and net manufacturers, product distributors, and advertising companies. A recently published study analyses the use and awareness of ITNs in Uganda. It can be accessed at tMark%20Uganda%202006%20HH%20Survey%20FINAL%208-23-07.pdf...
Submitted by craig lefebvre on October 16, 2007 - 08:52.
There are many difficulties inherent in taking on an ideology that seems more intent on 'winning' over social marketing than helping the poor and building the capacity of the private sector. Thanks for pointing out the very real consequences of this type of 'helping.'
Submitted by Eddie on April 14, 2008 - 14:45.
In the past whenever there are 'public events' or charity shows such as Live Aid, one often wonders how the money is spent. We assume in the warmth of our houses that it will be wisely invested and given to the needy, but I guess we forget that the real progress is made by the people who educate and work their butts off to help people under these extreme circumstances. If only governments worked to build community with less wealthy countries rather than give handouts and forget the real issues, maybe we wouldn't have those problems. Anyway, enjoyed your post.

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