Willingness to pay for treated bed nets

Tanzanian policymakers could increase the coverage of Insecticide Treated bed Nets (ITNs) in malaria-endemic areas by capitalising on the people’s willingness-to-pay for them, a study says.

Researchers in the study published last month in the Malaria Journal say this can be done in conjunction with other public sector distribution channels.

Findings from a study published July in the journal, involving 800 households in Ruvuma and Mwanza regions suggested that there is a private demand for nets in Tanzania which could potentially supplement future campaigns to increase the coverage of ITNs in the country.

Since 2008, the World Health Organisation (WHO) has recommended universal coverage with ITNs in Sub-Saharan Africa, in the effort to reduce malaria morbidity and mortality. The aim is to provide one ITN for every two people in regions of high malaria transmission.

When people are willing to pay for the nets

In Tanzania, there have been campaigns to ensure free access to ITNs to children under the age of five from 2008 and 2010 and free universal coverage campaigns in 2010, 2011 and 2015.

However, during the recent study, titled: Demand and willingness-to-pay for bed nets in Tanzania: results from a choice experiment, Prof Chris Gingrich from Eastern Mennonite University and a team of researchers from Tanzania found that households in the two regions studied preferred ITNs with certain market characteristics, such as size of the ITNs, shape and whether they were treated with insecticides or not.

The study targeted parents of school children. Out of those who were interviewed, 40 per cent chose to buy a net across all seven combinations of net prices and characteristics such as size, shape, and insecticide treatment which were selected for the study. Only 8 per cent of all participants chose not to buy a single net, said the study.

A key factor influencing demand was whether a participant’s household currently owned sufficient nets for all members. People in rural areas showed lower net coverage and greater demand than urban participants, the study found.

The study concluded, “Net manufacturers and retailers should advertise and promote consumers’ preferred net attributes to improve sales and further expand net access and coverage.”

Gingrich, who is Economics Professor, said free distribution of ITNs should no longer be the sole means of ensuring the coverage of ITNs.

He said,“… mass distribution campaigns of free nets need not be the sole means of dissemination since most households also show a willingness to pay for supplementary nets where needed.”

“To encourage purchases, private net sellers should promote those characteristics the study found that households value most, namely square shapes, large sizes, and pretreatment with insecticide.

Consequently, net coverage and use should increase, thereby reducing malaria incidence.”

The challenge

During a study funded by United States Agency for International Development (USAID) and the US President’s Malaria Initiative (PMI), the researchers preferred to interview households in Manyara and Ruvuma.

“…because these regions had had been recently involved in bed net programmes under the national subsidised voucher scheme for pregnant women and infants from 2004 to 2014,’’ said Dr Amos Kahwa, a researcher from the National Institute for Medical Research(NIMR); who co-authored the study.

“We had an assumption that the recipient households would show little interest in buying additional nets. But we realized there was a class of people who valued the nets to an extent that they were ready to purchase them as long as they had marketable attributes,’’ Dr Kahwa said.

Dr Kahwa said that it was important to do the study now because the bed net coverage in Tanzania was facing challenges. “There are people who were given free bed nets and they chose to use them for other purposes such as turning them into fishing nets. There was need to reassess the demand characteristics for the nets and find out whether people value them.”

Experts’ take

But, a Tanzanian Epidemiologist based in Dar es Salaam who did not take part in the study, Dr Frederick Haraka, said the idea to increase ITNs coverage is indeed logical, but, he suggested it needs to be tested before it could be circulated widely.

Another researcher who didn’t participate in the study, Dr Peter Asilia from Ifakara Health Institute (IHI), believes that when it comes to malaria prevention through ITNs, it’s high time people were empowered to decide on what works best for them.

“We, as stakeholders just need to improve from the angles where they [the people] can’t go above, instead of using the vertical approach in any intervention that touches the community well-being,’’ Dr Asilia told Your Health.

Currently in Tanzania, 90 per cent of the population live in areas that carry a high risk of malaria transmission, the National Malaria Control Program reports.

Tanzania has the third largest population at risk of malaria in Africa, says malariaspot.org and each year, 10 to 12 million people contract malaria in the country and 80,000 die from the disease, most of them children.