23 March 2011 ~ 8 Comments

Giving away one bednet doesn’t “save one life”…. sorry!

Ahh, bednets. NGOs sell the idea of giving things away by equating each thing we give away to “the poor”, like a bednet, as equal to “saving a life”. If only it were that easy….

This week a fascinating group of visiting students told us about a campaign that had happened in their school to send bednets to Africa. They spent their week with us as we all learned more about how to be a responsible donor, and eventually we touched on several points that lead all of us to agree that sending bednets to Africa is perhaps not the best way to “save the world”.

Let’s analyze some of the problems.

What time of day to mosquitos usually feast? When are you usually itching and scratching and putting on bug spray?

If you said sunset, then you’d be CORRECT!

So if YOU don’t usually hang out in your bed at sunset, and the “poor people” we seem to all be trying to “save” are working in Cambodia (or your favorite African country) until sunset, well then THEY probably aren’t hanging out in their beds at that time either. In other words, bednets are indeed IMPORTANT, but they are not the holy grail of health. Bednets alone do not “save” ANYONE from malaria; rather they are only a PART of the solution.

What else is needed to combat malaria? Well, in Cambodia (where I’d like to note that malaria is not prevalent in many parts of the country – much less so than in places like Papua New Guinea) deaths from Malaria are very preventable. No one should be dying from Malaria here – there are medicines, free clinics, and lots of groups trying to “save” people with bednets.  So why would anyone die of the disease here anymore?

Some people get very ill from malaria because they avoid a visit to the doctor right away and wait until they are near-death before going in order to avoid wasting money. In addition, there’s often a lack of knowledge regarding malaria. Many people don’t know:

– Where malaria comes from

– How to prevent the spread of mosquitos in and around their home

– How to tell the difference between malaria and the flu

– How severe the illness can become if left on treated

– The ease with which the malaria can be treated

– Which local remedies are effective

– The availability of medicines in urban areas

– Where they can get treated

– If a free clinic exists nearby

This lack of knowledge is a direct consequence of benefactors relying on giving away THINGS, like bednets, without investing the time in education or connecting people to the other resources and information they might need.

We can’t continue to dumb down statistics and create false facts. A bednet does NOT save a life. It’s a part of the solution, but it’s the EASIEST and QUICKEST part. It’s a tempting solution, because we can act instantly, and then pat ourselves on the back for a job well done. We can’t keep advocating that THINGS are the only solution – that giving out a bednet, equates to saving a family.

We all know our time is the most valuable resource that we have, so we create false metrics to help us save time and fool ourselves into thinking that we achieved guaranteed results, because anyone can walk out the door and give away a mosquito net. It’s not as easy to walk out the door and “save a life”. Mosquitos are sadly still biting at sunset, and although NGO marketing material might tell you otherwise, our things aren’t out there “saving” people for us.

Reminder to self: There’s more to it than giving things away.

  • Nikola

    Hey D – I know the point of this article is to highlight a point you are passionate about ie. not giving things away. I don’t know what metrics are saying that bed nets single-handedly save lives, but it can’t be argued that they’re not important (WHO report here http://www.who.int/topics/malaria/en/). Surely if an NGO that says it works in the prevention of malaria and did not advocate for the use of bed nets would be negligent, given the research? nnAre you saying that the specific campaign the students undertook for donating bed nets was insufficient (I’m sure they explained the details to you that you didn’t include here)? Or all are? It kind of sounds like you think people shouldn’t give anything away! Can you give an example of an NGO that effectively uses THINGS that are donated as part of their education program in health or any other field? I’m sure you can name a million that use THINGS ineffectively…but an example of one that does it effectively might help know how to assess a good campaign or not.

  • Anonymous

    Thanks, Nikola, for the reminder, to always add a counter story and a call to action for how to consider a better alternative. You wrote, “It kind of sounds like you think people shouldn’t give anything away!” YES! I don’t think giving things away is a good strategy, not just about bednets. As mentioned, bednets of course are part of the need to prevent malaria, in the same way schools are part of the need to improve access to quality education… but not THE solution. In this post I link to a blog post called “9 reasons to not give things away” and add a few ideas of my own: http://lessonsilearned.org/2009/08/lesson-learned-why-we-shouldnt-give-things-away-or-sell-them-for-cheaper-than-they-really-are/nnAt the bottom of this post http://lessonsilearned.org/2010/02/changing-attitudes-and-actions-takes-more-than-giving-things/, I added some ideas for how I would vet an organization when it came to the impact of the things they were distributing (for example: The focus is on putting u201cthingsu201d and ideas to use, not just distribution. If there is a physical item being donated or sold, what are the plans for education and support around repairs, usage ideas, and markets for further local-led distribution.) nnIn that same post, which I wrote nearly a year ago about the same topic as a guest post for Philanthropy Indaba I mentioned a project I liked which didn’t just focus on things, but how to use those as a way to change attitudes and actions:n—nnOne organization I have come across that really understands that educating people is the key to putting technologies to work is the team at Resource Development International Cambodia (RDIC). They make a rope pump which iss made entirely from locally sourced materials including rope and PV tubes. It fits on top of a traditional open well and sells for about $250. Though much cheaper than the deep tube wells installed by many NGOs, the price is still cost prohibitive for most families, so RDIC has a two year repayment plan. At RDIC, they recognize that the core changes they are looking to see donu2019t have to do with things as, in this case, they are looking to see reductions in the number of people with water born illnesses. With 24 repayment days where an RDIC employee collects the payments, they have a chance to teach 24 lessons to ensure that they reach their goals of improving health. Lessons have to do with in-home water filtration, how to fix and maintain the new rope pump, home dug toilet solutions, hygienic food preparation, and more. They not only have 100% repayment on their rope pumps, but they are making changes in attitudes and actions surrounding health issues.nn–nI hope this helps clarify my thoughts on giving things, N! I appreciate the questions and questioning!

  • Anonymous

    PS – here is a post from 2009 where we were looking at the “sustainability” of our programs and trying to define what that meant. In there, I looked at how we were trying to move away from “giving things away” – and how sometimes we felt that doing that, when matched with ongoing efforts to put those things to use, was as short-term solution which we could match with more long-term ones. In there I wrote:nn”And yet, we were still giving stuff away with limited accountability or investment from the community and making many decisions without community involvement. Itu2019s hard to be patient. Our programs seemed to have diverged down two paths, the u201cinvest in the now and see results soon: in this class, in this person, in THIS generationu201d path, and the u201cdonu2019t do, teach; donu2019t give, inspire: incremental change will happenu201d path.”nnhttp://lessonsilearned.org/200…nnUnlike some of the posts from a few years ago, I still largely agree with this one. The more we invest in people, rather than things, the more I think our impacts are “sustainable”, even if the financials are not.

  • Nikola

    So it is ok to give away things to an NGO you trust will deliver them as part of a program that they deliver responsibly? I don’t mean dumping a bunch of bed nets somewhere and expecting it to work – I mean, if I wanted to give the rope that RDIC would use in its pump to reduce the cost, that would be ok? It’s still giving a THING away…people need THINGS! And if a trusted NGO knows what THINGS they are – shouldn’t we believe them? #justbeingpractical :)n

  • Anonymous

    Of course! That is the main point… we need to find “a trusted NGO” that is doing great work – and that THEIR work isn’t just giving things away. If we give things like rope to them instead of money and then they integrate that rope into a more holistic approach – fabulous! That though is a little different than the point of the post in that the concept of “a bednet saves a life” sells the wrong ideas to donors. I understand that we can’t explain every detail of the work we do to donors, but those organizations who recognize that a bednet is not the whole solution (or ideally who aren’t relying on “giving things” at all but rather supporting education which creates value in those things and thereby incentivizes more long-term market based solutions which might start with discounts and then grow to sustainability perhaps) should find a way to speak to those. In that way, we aren’t always selling a really stretched “fact” like equating saving a life with a thing – and when donors are better educated about the REALITIES of what goes into saving a life, they will be better able to invest in the most successful solutions based on impacts (not inputs) in the future. Thoughts?

  • http://twitter.com/poverty_action IPA

    There has been research showing that giving away bednets is no less effective than making people pay for them: http://www.poverty-action.org/provenimpact/bednets/highimpactnnThere is also a strong economic argument for giving things away for free when there are positive spillover effects. If half of a village uses a mosquito bednet, the other half also benefit because those nets block the transmission of malaria.

  • Anonymous

    Thank you for commenting, IPA team! I appreciate that you joined in – and the link. I don’t think that addresses the biggest problem though with giving things away. Looking at what we give away as a short-term solution means we only look at the effect on the community right now, but if we are looking for a long-term solution, giving things away can sometimes impede market based solutions from succeeding. nnIn this post from 2009 I wrote about how a well intentioned organization came to an area where we were working and practically gave things away – they sold water filters to the community they deemed too poor to pay for the filters at 1/3 of the market value. http://lessonsilearned.org/2009/07/giving-things-away-can-cause-more-harm-than-good-voluntourism-traveler-philanthropy-gone-wrong/ The result was that the local system of selling the same filters was then destroyed. In the end, the organization that had thought they were helping people get access to clean water ended up preventing people from accessing it afterall. nnThere are more thoughts on the topic here:nhttp://lessonsilearned.org/2009/08/lesson-learned-why-we-shouldnt-give-things-away-or-sell-them-for-cheaper-than-they-really-are/nnI am sure you know much more about giving bednets away than I do, so I would defer to you as to the long-term results of this type of project. I do though feel that from my general experience, I am usually drawn to market based solutions, patient capital approaches to investing, and solutions which allow communities to take ownership of their own futures rather than waiting for outsiders to provide the next batch of their most needed materials as I see them as better long-term approaches to success. That said, these types of solutions might sometimes need to come in parallel. nnAt PEPY, one of our least sustainable programs was our Bike to School Program. http://lessonsilearned.org/2009/09/are-pepy-programs-sustainable-part-1-of-2/ We were giving bikes to all 6th graders who went on to grade 7. We realized that we could keeping giving bikes away year after year after year… but if we do that, then when we stop, 6th graders will still need bikes. If we were only giving bikes away, we wouldn’t have created a more long-term solution to the problem such as: creating a cheaper way for kids to get bikes or other transport to school, bringing schools closer to people’s homes, increasing the impact and value of an education to the point that going to school became something worth investing more money in, etc. We later decided to change the program to only serve the kids who lived furthest from the school and had the biggest need and motivation, but recognize that is was not a sustainable solution and still needs to be done in parallel with other approaches like the ones listed above. We recognized that giving away one bike can’t be directly correlated with “providing an education for one child” – it’s part of a solution – and there are other inputs which would make for more positive long-term impacts. nnIt’s very tricky – I think we can probably all agree with that! Sometimes we need to choose short term solutions especially in times of disaster or for areas where better options will take a long time and can be done in parallel with other inputs. nnThanks again for engaging in this conversation.

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