Too poor to pay: charging for insecticide-treated bednets in highland Kenya
Sam, A. Ochola
Helen, L. Guyatt
Robert, W. Snow
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There is overwhelming evidence that insecticide treated nets (ITNs) have enormous potential for alleviating the burden of malaria in Africa. The challenge is to move beyond clinical and experimental trials to implementation at a national level. As with most effective public health interventions in Africa, a major barrier in going to scale will be economic. Most governments in countries with endemic malaria would not be able to afford the provision of these preventative measures from existing budgets. One approach to financing health care in developing countries has been to ask communities to pay for these services. Willingness to pay (WTP) studies have emerged as the fashionable approach to establishing the potential of such cost recovery schemes. They have been widely used in the health field as a marketing tool to help in setting prices prior to introducing user fees, and to provide information on potential demand and revenue (Russell et al. 1995). Most research on cost recovery treats WTP as synonymous with ability to pay as ‘Consumers are assumed to be able to afford whatever they are willing to pay, because they know best how to allocate their resources’ (Russell 1996). Guidelines for defining affordability do not exist, but one approach has been to consider the opportunity costs of payment on other household expenditures (Russell 1996). This paper presents a comparison of the WTP responses for ITNs in rural homesteads of highland Kenya with the ability to pay as assessed from current household expenditure.