Global Health Controversies: Local vs Outsider solutions – Part Two

(Parents and children waiting for oral rehydration solution. Photo credit: sanjoyg)

The arguments against imported solutions come down to three things. First of all, imported solutions tend to leave communities convinced that they cannot solve their own problems and must have outside help to function. Two, they are expensive and therefore difficult to sustain. Three, it leaves communities at the mercy of a volatile global market. All of these are powerful arguments.

Treating malnutrition or diarrhea with an imported product in a foil packet labeled in a foreign language doesn't really give parents the skills to keep their children healthy. It teaches then to go quickly for help to the clinic or feeding station, but it doesn't give them any knowledge of what to do in the event that the clinic or feeding station is closed or departed. Teaching parents how to mix their own rehydration solution does. Malnutrition is trickier, as it doesn't stem from a lack of knowledge but a lack of food. Even it that case, however, using locally available foods to treat it would empower communities to address their own malnutrition cases in the future instead of relying on imports. Could you make a therapeutic food locally? I don't know, but peanuts are not hard to grow.

Importing outside products is expensive. Even if the product is made of cheap ingredients and subsidized, transport alone costs money. The more expensive a product is, the harder it is to maintain funding for the long term. Plumpy'nut is a product intended for emergencies and theoretically will only be needed for a limited amounted of time. ORS, however, is for routine treatment of a common childhood illness. Until we eliminate all causes of diarrhea, we'll need oral rehydration solution. Nobody gains when that solution is too expensive to provide consistently.

Finally, when using imported drugs and treatments, developing countries end up at the tail end of a long global supply chain. This can be disrupted by anything from financial crisis to weather conditions to government incompetence. Both Uganda and Burma are currently facing stock-outs of tuberculosis drugs as a result of financial troubles and/or government mismanagement.

Both Plumpy'nut and oral rehydration solution have a near-miraculous ability to restore children to health. You can't argue with that. Should we be promoting possibly less effective local solutions instead? Your guess is as good as mine.