Type: Evaluation Essays
Sample donated: Heidi Caldwell
Last updated: September 30, 2019
In 1998, the United Nations and WorldBank initiated the Roll Back Malaria Partnership (RBM), a program aimed tocontrol malaria by improving collaboration between governments and donors, aswell as aid in vaccine and anti-malarial development, and prevention efforts. Malariaeradication efforts from previous decades were unsuccessful. In 2007, significantreduction of malaria incidence and mortality in certain countries wasattributed to increased distribution of long-lasting insecticide-treated nets(LLINs). Unlike traditional bed nets or conventional insecticide-treated nets(ITNs), LLINs last for years, are more effective at repelling and killingmosquitos, and are cheaper in the long run. As part of the greater malariaeradication effort, governments and donors purchase and distribute LLINs forfree or at significantly subsidized prices to citizens who cannot afford LLINs,with the ultimate goal of providing universal bed net coverage in Africa.
Aboutone decade since RBM’s revitalization of the malaria eradication campaign,funding for RBM and efforts to improve availability of and access to LLINs hasgreatly increased. UnintendedConsequence: (blind spots, myopias; rigidity of habit) One unintended consequence that hasoccurred from LLINs distribution is that Asian manufacturers are outcompeting alocal African company called A to Z Textile Miles, Ltd. that providesbetter-quality products and economic benefits for local communities that extendbeyond the immediate health benefits of bed nets. A to Z produces LLINs from a technologicallyadvanced polyester material that slowly releases insecticide over a long periodof time and is more effective and durable than ITNs or other LLINs.
A to Z isdifferent from other companies because it is the only company in Africa thatproduces LLINs. It not only reduces malaria transmission for people who use itsnets, but also provides thousands of jobs for community members, housing, aclinic, and a school for its workers and their families.Donors and governments purchase LLINsfrom Asian manufacturers instead of A to Z because they believe Asian LLINs arecheaper.
Unfortunately, this decision impacts more than just A to Z and is anexample of a blind spot or myopia leading to an unintendedconsequence. A to Z has created about 5,300 jobs that are primarily filled bywomen and that support over 24,000 surrounding community members. With changingfunding, policy, and priorities in global health, the seemingly innocuouschoice of purchasing supposedly cheaper nets from Asian manufacturers overlocally-made nets may mean that donors are indirectly destabilizing thousandsof African people’s income livelihoods, and undermining a company that isdedicated to promoting child and maternal health, economic development andsustainability in Africa.One Cause of Unintended Consequence: Bureaucratic Authority This unintended consequence can be partiallyexplained by rational-technical authority, also known as bureaucraticauthority. The WHO Pesticide Evaluation Scheme (WHOPES) was established toencourage pesticide testing, and also regulates commodities with pesticides thatwill be used for public health programs. WHOPES established three qualification”phases” that commodities had to pass in order to be sold and distributedthroughout sub-Saharan Africa. These three qualifications include: 1) “Mosquitomortality or knock-down after at least 20 standard washes,” 2) effectiveness inexperimental settings, and 3) effectiveness at various village-level settingsover three years (“The Global Health Delivery Project”). In order to quickenLLIN distribution in Africa, WHOPES only required that nets fulfill the firsttwo qualifications.
Unfortunately, this protocol means that LLINs that are notas durable or effective, such as those from Asian manufacturers, may still bedistributed, even though more durable and effective LLINs that have passed allthree requirements, such as those from A to Z, exist.To compound the ineffectiveness of thesebureaucratic practices, policies require that companies provide quotes that donot include insurance and freight costs to potential purchasers. Asian LLINs havemore competitive quotes, but their high insurance and transportation costs actuallymake their total costs more expensive than A to Z’s LLINs. Although LLINs manufacturedin Asia are less effective, they outcompete A to Z’s LLINs because donors andgovernments choose the supposedly cheapest products among WHOPES-approved nets.WHOPE’s two protocols are examples of bureaucracy implementing procedures inorder to make more efficient decisions and standardized outcomes.
Together, theprotocols have actually led to economic waste on the part of the donors andgovernments with limited budgets, as well as inferior products for the peoplewhom these entities are trying to help. Better Foresight:Anticipation and AversionThe unintended consequence of A to Zbeing outcompeted could have been anticipated and averted with better researchand knowledge about the impact of different manufacturers on the local Africaneconomy and about the quality of different LLINs. With that knowledge, decisionmakers could have implemented policies that included information about the trueprice as well as the unequal economic and social impact of differentmanufacturers and their LLINs. In addition, donors and governments could havechosen A to Z’s LLINs despite WHOPES certification of other LLINs.Unfortunately, WHOPES knew there differencesin LLIN quality exist, hence their qualification system, but they chose to certifyproducts that did not satisfy all requirements because they wanted more LLINsto be distributed. WHOPES, along with donors and governments had a short-sighted, myopic view of malaria eradication; they aimed to increase LLINcoverage in all of Africa, but as a result, they distributed nets that are morecostly and ineffective in the long run, as well as generated economicconditions that challenge companies in the local economy and threaten the livelihoodsof thousands of locals.
If WHOPES had a more comprehensive and longer-term viewof malaria eradication that considered the effects of LLIN production, such aseconomic stimulation, on the community of people they are trying to help, aswell as the longer-term effectiveness and cheaper cost, WHOPES as a regulatorybody could have informed net purchasers about these differences. Ultimately,they could have averted the unintended consequence of generating considerableeconomic competition against better companies such as A to Z.