The Mosquito Trap

How many of you have heard of Yorkool mosquito-nets? Evidently, Yorkool International Trading Company is based in Tianjin, China, and competes in the Indian mosquito-net market with brands such as Dawa Plus, Duranet, Lifenet, Olyset, Permanet, Royal Sentry, Magnet and many others. We discovered this because the questionnaire used for National Family Health Survey (NFHS) 2019-20 suggests that your brand preference is an important question being pondered upon by policy-makers.

The NFHS surveys collect household-level demographic information and also socio-economic data. Since National Sample Survey household consumer expenditure surveys had been inordinately delayed, NFHS-5 conducted in 2019-20, has been used to gauge socio-economic improvements. For instance, India's recent improvement in UNDP's multi-dimensional poverty index (MDPI) is largely because of NFHS-5. A lot of thought goes into devising questions asked in surveys, based on expert advice, such as that of International Institute for Population Sciences.

Nonetheless, some questions are somewhat odd. For instance, NFHS-5 collected information on ownership and use of mosquito nets. There is a slight difference between LLIN (long-lasting insecticide treating net) and ITN (insecticide-treated net). LLIN nets have insecticide in their fibre, so efficacy is more than of mesh alone and the insecticide lasts for 3-5 years (20 washes). ITN nets are ordinary nets treated with insecticide. Twice a year, they have to be re-impregnated with insecticide. Hence, though ITN will be cheaper than LLIN, LLIN is better. NFHS-5 asked questions about LLIN, but reported ITN usage.

To quote NFHS-5, "An important strategy in the control of malaria and kala-azar is prevention through use of mosquito nets to protect themselves from mosquito bites. More than one-third of households (36%) in India have at least one mosquito net, while 8 percent have at least one Insecticide Treated Mosquito Net (ITN)…The proportion of households having at least one ITN for every two persons who slept in the household last night is highest in Nagaland (43%), Arunachal Pradesh (35%), and Mizoram (26%)." Not surprisingly, poorer households (lowest wealth quintile) use ITN nets more than richer households (highest wealth quintile); rural households use ITN more than urban ones.

For India, malaria is a public health problem, primarily because of the Plasmodium vivax and Plasmodium falciparum, though the minor parasites are not unknown. Mortality, morbidity, dengue, chikungunya, lymphatic filariasis, Japanese encephalitis, not to forget out-of-pocket expenditure. Admittedly, there are geographical (and seasonal) aspects. But one should do something about mosquitoes, as contemplated in National Framework for Malaria Elimination, visualizing an end to malaria by 2030, with a focus of high endemic districts (based on annual parasitic incidence (API)). Notwithstanding huge mismatch between WHO and government figures (primarily because of estimated cases treated in private sector), there is no denying number of malaria cases and deaths has declined, quite sharply. PM has also spoken of 2030. For India to be certified malaria-free by WHO in 2030, starting in 2027, there have to be zero cases. Having granted importance of fight against mosquitoes, are people always in bed, or do mosquitoes not bite during the day, or in the evenings? Then there are repellents (coils, vaporizers, mats, creams). Each has pros and cons and household decisions on use vary, depending on availability of electricity, socio-economic status, educational level, and on whether the individual is vertical or horizontal (on a bed).

It's a bit odd then, that NFHS asks no questions about use of these other methods, though localized surveys show people use such repellents much more than they use nets. Indeed, Odomos is so ubiquitous that it is now a common noun. Surely, policy-makers care more about the range of methods rather than the brand of nets.

In other words, NFHS questions don't tell us much about household behaviour, which ought to be focus of such surveys. Instead, as with donor-driven interventions in other countries, presumption is that it must be nets. Not only is one asked about nets, one is asked about whether these nets were purchased from the market, or obtained through government/NGOs. This is understandable, because supply-driven government initiatives have involved distribution of nets to targeted villages and there are elaborate guidelines for this.

Still, when a household is asked about ownership of a television, NFHS doesn't ask about the brand. Rightly so, for it is not a market research agency. What then explains the question (no.78 in the schedule) about brands of LLIN mosquito net? This question about brands is unique to NFHS. The explanation may be that WHOPES (World Health Organization Pesticide Evaluation Scheme) has a list of LLIN mosquito net suppliers, Yorkool included. With the exception of DK (made by DK Enterprises), all the other mentioned brands figure in the WHOPES list. If one may say so, question 78 is about a WHO agenda, not India's development agenda. That is why those details about brands figure in the schedule, but not in the final NFHS-5 report.

This is just one instance where India's data-gathering agencies have drifted away from real policy issues. Apart from the mosquito-net issue, the NHFS still has specific questions for black and white televisions, clocks, and fixed-line phones. Survey questionnaires now need to be re-worked from first principles in consultation with today's policy-makers rather than blindly perpetuating past questions or being highjacked by donor interests.

(Bibek Debroy is Chairman, and Sanjeev Sanyal, Member, Economic Advisory Council to the Prime Minister)