A Program to Fight Malaria in Africa Draws Questions
Though its budget for fighting malaria has risen since 1998 to $90 million from $14 million, the United States' foreign aid agency is spending 95 percent of the money on consultants and less than 5 percent on mosquito nets, drugs and insecticide spraying to fight the disease.
The spending priorities have touched off an intense debate between the agency, the United States Agency for International Development and its critics, who include two of the Senate's most conservative Republicans.
The agency says it has decided to concentrate on offering technical advice while others buy goods. But critics accuse it of wasting its growing budget.
"We are spending most of our money on consultants and on meetings and not on getting actual care out in the field," said Senator Sam Brownback, a Kansas Republican who has introduced a bill to force the agency to spend half of its malaria budget on treatment.
The critics also accuse the agency of concealing how it spends antimalaria money. The list of contractors on its Web site has not been updated for four years, and Mr. Brownback said the agency gave him "vague descriptions and math that doesn't add up." He is demanding an audit by the Government Accountability Office.
Another senator, Tom Coburn, an Oklahoma Republican, has publicly suggested that the agency's malaria budget be given to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Geneva-based fund to which the United States has donated more than $1 billion.
Michael Miller, the aid agency's deputy assistant administrator for global health, could not give a detailed account of its malaria spending, but he told a Senate subcommittee on May 12 that much of the agency's technical advice had been helping foreign countries qualify for grants from the Global Fund.
Dr. Richard Feachem, the fund's executive director, agreed that such technical advice was often useful because the group has no field officers in the 130 countries where it makes grants. But he declined to comment on how much the Agency for International Development needed to spend providing it.
Mr. Miller said many poor countries know little about fighting malaria. Judging his agency by the goods it buys, he said, "is like judging an army based on the number of bullets it has - you have to have skills and training and know the battlefield."
The agency's spending patterns were brought to the senators' attention by Roger Bate and Benjamin Schwab, experts on third-world health at the American Enterprise Institute, and Amir Attaran, a professor of law and world health at the University of Ottawa.
Giving advice without aid amounts to "back-seat driving," Dr. Attaran said in an interview, contrasting the spending patterns on malaria to those on famine aid, for which the United States ships many tons of food.
Some of the agency's past advice has drawn sharp criticism from other malaria experts. Three years ago, as many African nations and global health charities were asking for money for a new malaria drug, artemisinin, the agency opposed them, saying cheaper, older drugs were still useful. Last year, after the Global Fund made artemisinin the backbone of its malaria programs, the aid agency endorsed it.
In his testimony before the subcommittee, Dr. Attaran cited an example of what he considered wastefulness: NetMark, a $65 million, seven-year program for "social marketing" of mosquito nets in Africa.
Instead of giving away goods that prevent disease, like mosquito nets, condoms or rehydrating salts, social marketers buy advertising, conduct public education campaigns and create brands, hoping to promote the goods at low prices in the commercial marketplace. The social marketers maintain that poor people value goods more when they pay for them instead of getting them free, and that small entrepreneurs can benefit from the sales.
Critics say this means that aid goes only to the "richest of the poor" in cities that advertising reaches, not to rural villagers who bear the greatest malaria burden.
NetMark is overseen by a regular contractor for the Agency for International Development, the Academy for Educational Development, a nonprofit corporation with an annual income of $225 million and 1,200 employees, most of them in Washington.
Mr. Miller said the NetMark program accounted for roughly 10 percent of his agency's spending for malaria, but is "not our only net program."
Mary Maguire, a spokeswoman for the academy, said 15 million people in four African countries were sleeping under nets because of NetMark campaigns, though she acknowledged that 5.8 million of those nets were supplied by "NetMark partners," several textile and chemical companies. "We don't sell nets," she said. "We have promotional campaigns to educate people about mosquitoes and brand malaria control. We build networks."
David McGuire, the NetMark project manager, said that the program had spent less than $30 million of the $65 million since 1999, and that 50 percent of the money was spent in Africa on advertising, local workers and matching grants to net wholesalers.
Mr. McGuire said he had no proof that malaria deaths had gone down anywhere NetMark operated "because we have no funding to do epidemiological research." But the project surveys households to see how many use bed nets and which brands they recognize, he said, "and when we got into this in 1999, there were zero commercial insecticide-treated nets on the market in Africa, and now there are at least 15 brands in the countries where we work, and even pirate brands from China."
"None of that would have happened without Usaid," he added.
The International Red Cross, another major donor in poor countries, takes a different approach: it gives free nets directly to new and expectant mothers, because infants and pregnant women have the highest risk of dying of malaria.
But Mr. McGuire said "free" nets often end up being sold by government health workers or channeled to better-off families with political connections. Also, he said, giveaways bankrupt small shop owners that sell nets. "The winds change and funding comes and goes," he added. "We wanted to make something that lasts longer than the donations."
Dr. Attaran said he was "a little shocked" to learn that NetMark did not give nets directly to people who need them.
"Do we really want to spend $65 million on advertising?" he said, suggesting that he thought it would make more sense to appeal to multinational companies "like Coca-Cola, who do a lot of advertising in Africa," to "give it to us pro bono."
Intensive net giveaway programs are safer than social marketing, he said. Studies show, he said, that when only a few beds in a village have insecticide-treated nets, the repelled mosquitoes simply bite other villagers.
Discover Yahoo!
Get on-the-go sports scores, stock quotes, news & more. Check it out!
_______________________________________________ Ugandanet mailing list Ugandanet@kym.net http://kym.net/mailman/listinfo/ugandanet % UGANDANET is generously hosted by INFOCOM http://www.infocom.co.ug/
