Regrouping in the fight against malaria

Celia Dugger writes in today's New York Times

It is no secret that mosquitoes carry the parasite that causes malaria. More mystifying is why 800,000 young African children still die of malaria per year — more than from any other disease — when there are medicines that cure for 55 cents a dose, mosquito nets that shield a child for $1 a year and indoor insecticide spraying that costs about $10 annually for a household. An emerging consensus on solutions, combined with fresh scrutiny and a windfall of new financing, are prompting major donors to revamp years of failed efforts to stem malaria's mortal toll.

Part of the answer lies in the way that the money has been spent:

Only 1 percent of the agency's 2004 malaria budget went for medicines, 1 percent for insecticides and 6 percent for mosquito nets. The rest was spent on research, education, evaluation, administration and other costs.

Owen comments: I suspect that USAID is not alone in spending too little on drugs and bednets and too much on conferences, consultants and technical assistance.

There is an interesting question here about incentives within the aid agencies.  Our incentives are to make our reputation by developing new ideas, introducing new programs or leading change.  There is a much smaller incentive to adopt a good idea that has been proven to work and to take it to  scale.  Because we have few effective measures of output of individual activities, we have no incentive to be completer-finishers.   As a result, we are constantly analyzing and criticizing, having conferences and evaluating.   We spend huge sums on very expensive ex-patriate technical assistance - part of that Amir Attaran calls "the foreign aid industrial complex".  Of course it is always important to evaluate progress, and to try to do better with the resources we have got, but sometimes we should just get on and do what we know is effective.