The work isn’t easy. About 19,000 nets are currently distributed in an area needing 200,000. Their proper use requires education. At a ceremony I attended launching a local anti-malaria campaign, a Zambian government official threatened to confiscate bed nets employed as fishing nets or sewn into wedding dresses.
Despite such obstacles, anti-malaria efforts in Zambia have a history of success. From 2001 to 2008, Zambia saw more than a 60 percent reduction in inpatient malaria cases and deaths. The methods of fighting malaria are reliable and relatively non-controversial: long-lasting insecticide-treated bed nets, indoor residual spraying of insecticides and treatment with effective new drugs.
Successful anti-malaria efforts are an odd hybrid — part military operation and part church meeting.
The logistics of distributing nets and spraying insecticides require martial scale and organization. Gains against other diseases come arithmetically, dose by dose. Gains against malaria come exponentially, as chunks of geography are secured.
But bed nets can’t simply be thrown off trucks. Their employment depends on human behavior. And behavior is influenced only by trusted institutions. So the Anglican Church in Zambia organizes volunteer malaria control agents, each charged with overseeing perhaps 15 households — making sure the nets are properly installed and not used for fishing and weddings. The success of a vast anti-malaria campaign ultimately depends on a group of compassionate, slightly nosey church ladies.
The whole effort is only sustainable if local governments take leadership and gradually assume greater burdens. Here, Zambia is fortunate. Its new president, Michael Sata, is a former health minister. Zambia’s first lady is a former OB-GYN. Zambia’s current health minister worked at the World Health Organization for 20 years. The government’s first budget increased health spending by 45 percent in a single year — a commitment permitted by sustained economic growth and the rising price of copper in Zambian mines.
But much of the progress against malaria here has been made possible by the United States, particularly through the President’s Malaria Initiative (PMI) — which has provided millions of nets in Zambia, including those distributed by private groups in Mongu. It is an unexpected intervention for a superpower. China, for example, has taken a different approach in Zambia — providing foreign assistance in exchange for resource concessions. And China out-invests America in Zambia by more than 10-to-1. China’s influence is everywhere — and resolutely self-interested.
The American Embassy, in contrast, is mainly a health-care provider. Of the $400 million the United States spends each year on foreign assistance to Zambia, about $370 million goes to fighting AIDS and malaria.
Zambia has issued a recent judgment on the merits of China’s transactional, extractive foreign policy. President Sata ran and won on a platform opposed to outsized Chinese influence. Upon taking office, his first diplomatic meeting was with the Chinese ambassador — whom he publicly excoriated for bad Chinese labor practices. Sata’s first public reception honored the Peace Corps and USAID — America’s aid agency.
In much of sub-Saharan Africa, the American image is now defined by the Peace Corps, by PMI and by PEPFAR, the American AIDS relief plan. It is a form of influence that is hard to measure or weigh. But people remember when you help to save their children.