Letter in The Economist about anti-malarial bednets

Giving Evidence’s Director, Caroline Fiennes, has a letter in The Economist this week.

Giving Evidence’s existence is about directing philanthropic resources to effective & cost-effective work. So we were horrified by a letter in The Economist two weeks ago which appeared to claim (it was rather unclear) that anti-malarial bednets “fail” because they [all?] get used for fishing. It’s just not true. Masses of high-quality research evidence shows that bednets reduce incidences of malaria and thus save lives. (Plus, as you will know if you have ever slept in a room with mosquitoes in, save much annoyance.)

Many philanthropic donors fund bednets – from people donating £2 right through to the Gates Foundation. It is not acceptable for them to be deterred from supporting that life-saving work by erroneous information. So Caroline wrote in The Economist to put the record straight – along with long-time ally Professor Paul Garner of the (relevant!) Liverpool School of Tropical Medicine, and Co-ordinating Editor of the Cochrane Infectious Diseases Group. (Paul invited Caroline to give a talk (which is here) at the Liverpool School, having seen her on BBC News talking about charities and evidence (here) in the wake of the charity Kids Company collapsing.)

Our letter says:

Alex Nicholls rightly warns against focusing on outputs rather than outcomes in philanthropic programmes (Letters, October 16th). But his example, that antimalarial bednet schemes “failed”, is incorrect. Contrary to some reporting, few bednets get used for fishing. A four-country study of over 25,000 bednets found fewer than 1% were being misused. A comprehensive analysis by Cochrane, an independent network of researchers, of 23 medical trials encompassing nearly 300,000 people showed that bednets reduced deaths by a third. A study at Oxford concluded that they averted around 663m cases of malaria in Africa between 2000 and 2015. These important outcomes, by charities and others, should be applauded.

Here are the studies that we cite:

There is a persistent trope about bednets getting used for fishing. Here are two relevant facts about that:

  • Fishing communities are only 1% of Africa’s communities at risk of malaria, according to Professor Pascaline Dupas, a development economist at Stanford. (https://web.stanford.edu/~pdupas/Dupas_letter_editor_NYT_malaria_nets.pdf).
  • Bednets don’t last forever – they get holes etc. So even if some are used for fishing, that doesn’t prove that that was INSTEAD of being used over beds. (None of which is a comment on the effect of bednets on fish-stocks. We’re only talking here about whether bednet ‘fail’ at their primary goal of preventing malaria – which they don’t.) 

To be clear, Giving Evidence has no professional or commercial interest in bednets. We don’t work in that – other than as an illustration of cost-effective work. We are just trying to keep people alive.

We don’t know why Alex Nicholls, an Oxford professor of social enterprise, wrote that letter. Nor what evaluation/s he was using. We have asked but he hasn’t replied. We also asked which specific bednet programme he was referring to: he hasn’t answered that either, but in fact the sole bednet programme cited in the article to which he referred is hypothetical, so it makes no sense for him to claim to know its results(!)

Sometimes the term ‘social enterprise’ is used to mean ‘pro-social or pro-environmental organisations that charge money’ so as to be financially viable. Bednets may sit badly with that philosophy because the evidence (see graph below) is that charging for bednets massively reduces usage and hence results – i.e., there’s a trade-off between earned income and impact. 

In fact, in every instance that we’ve examined, it turns out that charging for the product reduces uptake and results (including bednets, soap, solar lamps). ‘Impact investors’ beware. Caroline wrote in the Financial Times about that, here.

Making giving decisions based on sound evidence, rather than random anecdote, ensures that our resources are best used – and keeps people alive. This is Giving Evidence’s work. If you would like to talk to us about your giving, please get in touch.

(Source: JPAL, The Price Is Wrong, 2011 here.)

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