It would be an understatement to say that my article “Celebrity Stunts of Altruism are Killing Livelihoods in Africa,” didn’t get any link-love. It went beyond that. It kick-started a wide-ranging debate that touched on all sides of Ashton Kutcher, malaria, foreign aid, and Africa’s place in the aid debate. I have been really humbled by the response, and from both sides of the issue. An overwhelming majority of you took the time to post thought out, meaningful responses to the post and defended your positions passionately whenever challenged. Some of you even picked up where I left off and spun your own blog posts on the issue, replete with even more insightful comments. It was the hot topic for a few days, and rightly so. Today, the whole saga culminates with World Malaria Day, as we turn our attention to the notorious malaria-spreading vector, the mosquito.

Invariably, the world’s attention will also turn to Africa, And rightly so. So I want to push the debate a little further, and hopefully I’ll address some of the comments from the previous article.

Africa is the last remaining unconquered malaria strong-hold. Malaria is very disruptive to all areas of society. From keeping an able work-force bed-ridden to downright killing those without strong immune systems, especially children. But it’s nothing new to us. Malaria has been around for centuries. Africa has been dealing with malaria way before Vasco Da Gamma rounded the Cape of Good Hope, and it was there when King Leopold plundered Central Africa. It was there during slave trade and there during colonial rule. Malaria doesn’t happen once a year. It’s not another fabricated day to feel-good-about-yourself for us. Malaria happens to us everyday. Starvation happens to us everyday. War happens to us everyday. And for that matter, diarrhea happens to us everyday as well. All of the above equally lethal.

I don’t mean to belittle the severity or nastiness of malaria, I’ve succumbed to that vector bug many-a-times! A few years ago, I was somehow particularly vulnerable on a trip to Uganda. I was down for the count twice with bad episodes of malaria during my trip. I got well-enough just in time to fly back in good shape. Two weeks later I was being rushed to the hospital. After a quick diagnosis, I was quarantined for 10 days. Every doctor in the Dallas/Fort Worth area and their interns came to poke, prod, “ooo” and “aah” like they just discovered a lost primate. And they all charged me for the privilege. My hospital bill could have bought enough bed nets for all of Malawi.

Yes! Malaria is a serious concern. My stance in my previous article is something I will always defend. It’s time for Africa to start manufacturing it’s own solutions to it’s most pressing problems. Our ability to do so is hampered by our dependency and largely, the West’s insistence that Africa needs more, aid. I’ll let Zambian economist, Dambisa Moyo, articulate why Africa doesn’t need more aid. I will say this… there is no magic bullet to fix this problem, but that’s not a reason to keep doing the wrong thing. There are better solutions to be had than just throwing nets at the problem. No amount of congratulatory chest-thumping is going to change that reality.

For the last 60 year’s, developed nations have been throwing aid money at Africa as the panacea to all it’s ills. For all their efforts, we still have anaemic industries, and decrepit civil services infrastructures, like health care. Had the aid empire done it’s job properly, Africa would have adequately dealt with the malaria problem. Surely throwing a good portion of that $1 trillion and a chunk of that 60 years could have solved the problem by now. Surely after 60 years and $1 trillion in foreign aid, there should be a mature healthcare system in Africa to tackle malaria without the need for Malaria No More. Surely there should more than ONE bed net factory in all of Africa with enough manufacturing capacity to deliver bed nets.

Malaria is something we can do something about. Just because we can’t right now, doesn’t mean we shouldn’t start the journey to self-reliance. True, we don’t have adequate bed-net manufacturing facilities, so let’s invest in more facilities to address this market need. We aren’t growing enough artemesia and pyrethrum to adequately supply the bed net manufacturing process, you say? Pay more farmers a decent wage to grow more. More capacity means cheaper costs of manufacturing. Basic, laws, of economics. Supply and demand. Market solutions. There are more ways to fight malaria than handing out imported bed nets.

Dambisa Moyo echos my opinion about aid effectiveness in her book, Dead Aid, the unintended effects of continually letting Western organizations trump solutions for Africa. Here’s an except:

There’s a mosquito net maker in Africa. He manufactures around 500 nets a week. He employs ten people, who (as with many African countries) each have to support upwards of fifteen relatives. However hard they work, they can’t make enough nets to combat the malaria-carrying mosquito.

Enter vociferous Hollywood movie star who rallies the masses, and goards Western governments to collect and send 100,000 mosquito nets to the afflicted region, at a cost of a million dollars. The nets arrive, the nets are distributed, and a ‘good’ deed is done.

With the market flooded with foreign nets, however, our mosquito net maker is promptly put out of business. His ten workers can no longer support their 150 dependents (who are now forced to depend on hand outs), and one mustn’t forget that in a maximum of five years the majority of the imported nets will be torn, damaged and of no further use.

So what then to replenish the nets? Relaunch the Hollywood machine for another 100,000 nets? Or will Hollywood, after realizing nets don’t fixt the problem, now launch a new campaign to, as my friend Michael commented on my Facebook stream, “train the mosquitos not to bite humans?” If something isn’t done to change the status quo, it’s going to continue being an aging problem. It’s time we [Africa] stood up and said thank you very much, we’ll take it from here. After 60 years and nearly $1 trillion in aid projects that go no where, we’ll take it from here.

Malaria No More (MNM) has raised millions off commercializing the bad news about malaria. I commend them on their astute use of social media and marketing savvy to bring attention to their cause. Bravo. But it’s not enough. MNM claims to be working with ONE manufacturing facility in Tanzania. One? Out of 53 countries and they are working with one facility? How much of those millions of donor money do they spend on their NY and DC offices? MNM was started by Wall Street cats. It’s a self-sustaining celebrity-driven money machine! Therefore, it’s sexy to have your head offices in Washington and New York. Not so sexy to have your head quarters at the heart of your problem in Nairobi, Kampala, or Accra. It’s sexy to have celebrities trumping your cause for the day, but you can’t be bothered to have a single African on your board of directors. Paternalistic much? Investing donor capital to build entire manufacturing facilities in Africa is not sexy, (forget that it’d be more beneficial in the long-run to do so than signing a lease in NY and DC). Selling Africa’s sad story, apparently, is.

Before anybody goes slamming me on my stance, ask MNM to show you their budget. Some financial transparency please? 100 million nets by 2010 is great. What about the other 700 million sub-Saharan Africans? Oh, right. We’ll just sit around drinking tea and crumpets, waiting for Ashton Kutcher to deliver a net. One lump of reality or two?

CORRECTION: (My esteemed colleague here at PD was kind enough to point out a factual error)
TOTALLY not true. Malaria is a huge problem in all under developed equatorial areas including Honduras, Nicaragua, El Salvador, Guatemala and Southern Mexico, India, Southeast Asia… etc. I can’t stand behind that statement in your article… Would be great if you could revise… perhaps the issue is bigger in Africa, I don’t know, but Malaria is holding strong in Central America and often goes untreated … those governments are not much better at dealing with it than African governments are.

  1. Great post. I have a scientist friend who says that the malaria issue is a scandal anyway. With new forms of more environmentally friendly DDT, we could eradicate malaria in Africa at a fraction of the cost for all the other programs you've blown the cover on.

  2. I don't discredit Ashton's action. He was able to bring a lot of attention to the issue, and perhaps more so to the issue of how should the West approach the issue of aid in Africa. That said I hope that from this point on people do a little research before they make a huge PR push like that.

    It saddens me that the ONE net manufacturer on the ground might be put out of business because MNM imports most of their nets from other countries. I'm sure its the path of least resistance.. but we can't have that anymore.

    I think in order to fix this the public must be educated. Your articles have helped a great deal. Once they start requiring this of the NGOs, they will be forced to seek solutions that are sustainable within Africa (or Central America). I'm actually working on a project to do just that. But this is no time for a plug. đŸ™‚

    I'm not even going to comment on why some ppl in the West setup NPOs then spend lots of money on offices and fancy chairs in DC, NY, etc. that's just sad.

    Thanks for sharing!

  3. I'm still struggling with why local production is so important to you TMS. Yes the total benefits of the economic activity would be local if produced locally but if it can be done elsewhere for less and distributed for broadly, why is that not net better? What if Malaria no More was based in Nairobi, run by Africans, but bought its nets abroad?

    If you extend this logic to industrial activities, ability to import inputs is critical to developing new industries.

    Also, what does your ideal local capacity solution look like? A local based organization employing only Africans? Is there no help from outside, even if just financing? Do people pay for bed nets then? Or is the hope that governments subsidize them? We've seen huge drop offs in usage when people are charged for them, and little support for the sunk cost fallacy argument (since I paid for my bed net, I value it more).


    • Jenny,
      Thanks for continuing the debate and I'll be happy to address the points that you have raised.

      Local capacity building is important to me because, without that, then we are doomed to perpetual dependency. And it's directly because of that import of external solutions that retards our ability to develop solutions on our own. And I am surprised that you don't see the pattern here. We've spent over a century being told what to do, and what's good for us. From slavery, to colonial rule, and now, paternalistic neo-colonialist aid-mechanism that insists that no solution can be innovated in Africa for Africans.

      As for industrial activity, Import/Export is a function of trade. True, importing inputs is critical to the growth of new industries. But what industries does importing finished goods create? When you erode the ability of a local economy to be part of the production process, you doom them to dependency because they can't thrive economically in that industry. Importing finished goods kills off any competition and ensuresassociationslike MNM will be around for a long time because we will always need them.

      Foreign Aid plays very little in that economic matrix. Money, human resources, and knowledge are all imported. Think about it, the only thing we've been able to export successfully is bad news Africa this and bad news Africa that.

      Aid isn't new to us, it's been happening to us for the last 60 years to the tune of nearly $1 trillion. If it's your assertion that imported solutions can be had for cheap and be more effective, certainly they can. But sole reliance on these cheaper solutions has done nothing to strengthen our ability to stand on our own.

      Also, I think you missed my point entirely on a good capacity building model. If you want to help us truly, invest in our ability to create solutions for us. For example, anti-malaria ingredients grow naturally in sub-Saharan Africa. Employ farmers to grow artemesia and pyrethrum. Don't import synthetics. Invest in a local factory with financing to buy new equipment, expand, knowledge transfer of best practices. Still not enough capacity? Open new factories, packaging and distribution centers, in Africa. If there's a need, invest in a solution. Europe, China, America follow that model, why does Africa have to be treated differently. China didn't develop because it was given aid, China developed because the world saw a need and invested.

      Surely you can see cross-parallelshere. It's taken way less than 60 years for China to develop from a poor populous country to aneconomicpowerhouse. And that only happened because of investment, not aid or a sole reliance on imports.

  4. TMS – thanks for engaging with me and pushing my thinking.

    I agree with you 110% on the need to build local capacity (see my blog posting on it), but we have different ideas on what local capacity should look like. Malaria kills 1M people a year almost exclusively in developing countries. In my mind the goal is to prevent as many malaria deaths as possible, not to build an industry based in locally around combating it. Capacity should be about finding innovative solutions and most critically distributing them to people in need – from my point of view local capacity would look like locally based NGOs distributing and connecting to funding / production sources from wherever in the world it could be done most efficiently. I fully believe innovations are more likely to come from the ground where people have access to information at the micro level, but efficiency should be the priority.

    I don't think people should pay for bed nets and medication. If you agree with that, where does the funding for them come from? If you don't, I beg you to tell me why not. I don't think that people living at subsistence levels should have to decide between food, education, and health. I think people have a right to at least a baseline on these. But even if you don't believe in that, there is a clear case for government intervention and I believe aid, in the case of malaria — due to both the presence of externalities and the need to incentivize R&D.

    On the externalities end this is pretty straightforward, falling ill and dying from malaria incurs costs on society that individuals don't internalize. This justifies some form of subsidy to promote bed nets, medicines, etc and not a pure market driven solution.

    On the R&D side, well there's just not enough incentive in engage in R&D activities for diseases like malaria because the potential market is limited to developing countries. Here I think there is a clear role for aid — I support a purchase guarantee fund to incent competition and make sure drugs get produced not just researched. And from what I understand Nothing but Nets is working with a company who has developed nets which release insecticide over a 5 year period — so this is an example of aid promoting R&D activities that might not happen otherwise.

    Happy to have a separate discussion on promoting economic growth directly via private investment, I just don't see that as the primary goal here. Having said that, given transportation costs in Africa, there seems a clear opportunity to have the continent be the most efficient place to do production. I'm sure there are other an abundant other opportunities as well, like artemesia and pyrethrum as you point out. If economic activity can be generated locally in the fight against malaria, that's great.

    But I just don't think that's the point. I think the goal should be preventing as many malaria deaths as possible as efficiently as possible.

  5. What is really sad about malaria, speaking as a Kenyan is that pyrethrum whose active ingredient is the only botanical insecticide to which the anopheles moquitoe cannot develop resistance to, has been ignored.

    At one time Kenya was actually the worlds largest producer of pyrethrum commanding 70% of the global markets. However, corruption and underhand deals ensured that the bulk of the product was sent to US manufacturer Johnson.

    However, even with large buyers from the US and even Japan (Sumitomo), the Pyrethrum Board of Kenya which had exclusive marketing rights was mismanaged, so that pyrethrum farmers did not receive their just pay. Thus they started uprooting their farms to instead till other cash crops that would provide ready cash.

    It is even harder for local entrepreneurs who want to venture into the malaria control using pyrethrum-based products. The regulatory process to get a licence to sell any insecticide is skewed towards large (and mainly foreign owned) manufacturers.

    In 2003, I was personally involved in the pesticide registration process, which took one and half years (I have been told that was fast for the small business startup we were!). I remember well on the first day I went to the pest control products board I was met with stares of disbelief that such a small business-person such as myself could even put in an application!

    Even the Ministry of Health were adamant that mosquito nets were the only way to go, not wanting to hear of any locally produced alternatives. Even their second line of resistance of indoor residual spraying only had a minimal amount of pyrethrum.

    How a country that was the number one producer of pyrethrum and which yearly looses so many children under the age of 5 years to malaria, could be so conservative in finding a solution (which was growing just under their nose) baffles me.

    Africa by virtue of its climate also plays host to many other botanical plants that if entrepreneurs are given the chance can form the first line of malaria prevention. These include neem oil, jatropha and eucalyptus, amongst many others. The time has come to look within and not just wait with open hands for the next handout from the donors to fight malaria.

  6. What became of the search for a malaria vaccine? Is it just possible that big pharma figures it may not recoup costs of R & D and also make a profit from Africans who live on less than $1 a day?

    • If it isn't a problem they can profit from in the G8 then it's not on their radar… Research should be on-going in the entreprenurial/non-profit sector…

      Sent from my iPhone

  7. As an African living abroad, I can see both sides of the coin. I read your blog yesterday and have been mulling it over ever since. From the African side, there absolutely needs to be infrastructure and the ability to create jobs with African manufacturing. The problem is … governments. How much of the aid money sent to Africa actually gets to the needy after palms have been greased and pockets lined? In Zimbabwe, where malaria and cholera are rampant, there is currently no way a manufacturer could come in to make nets and create jobs without being seized by the state and being state run. So sending in nets is at least a way to try and help. I loved your blog but do think Ashton Kutcher got a bad rap! How aware were Americans of the malaria plight before the Kutcher/CNN race? I think that any time a celeb can raise consciousness about global issues, it’s a good thing. Bill Gates’s stunt releasing the mosquitoes at a symposium was priceless! Perhaps this is where the millions of Africans living abroad come in – in understanding both the African and Western cultures, knowing the strengths and weaknesses of both and fostering relationships. Barbara Kingsolver’s Poisonwood Bible perfectly describes the disparity between the two – the brash American preacher can’t understand why the villagers won’t let him baptize them in the river to save their souls whereas the villagers thinks he wants to feed them to the crocodiles! I would love to do my part for a stable and prosperous Africa. Hats off to all those who already are.

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