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380 mosquito nets

380 mosquito nets - 15 The demand for insecticide-treated...

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15 The demand for insecticide-treated mosquito nets: evidence from Africa Christine Poulos, Maureen Cropper, Julian Lampietti, Dale Whittington and Mitiku Haile 15.1 Introduction Brouwer and Koopmanschap (2000) discuss the differences between what they call the 'welfarist' and 'extra-welfarist' perspectives on economic evalu- ations of health interventions. The 'welfarist approach', characterized by Harrington and Portney (1987) and Berger et al. (1994), aims to embed evaluations in welfare economics. The 'extra-welfarist' approach, charac- terized by Cuyler (1991) and Williams (1993), aims to help decision makers maximize health from a given budget by 'replacing utility with health as the outcome of interest for evaluation' (Brouwer and Koopmanschap, 2000: 444). While Brouwer and Koopmanschap take aim at the controversial assumptions underlying welfarist evaluations, this study shows that wel- farist approaches convey information about individual behavior, which has implications for both health outcomes and health budgets. This study bridges the gap between welfarist and extra-welfarist perspec- tives by estimating a household demand for insecticide-treated bednets (ITNs) that allows policy makers to balance the goal of cost recovery against the desire to guarantee that a certain fraction of the population receives protection from malaria and other vector-borne diseases. ITNs have helped to reduce the incidence of malaria and other vector-borne illness in various parts of Africa (Binka et al., 1997), but their use as a health intervention raises an important policy question: should ITNs be provided privately or publicly? If they were sold privately, how many bednets would be purchased (at various prices)? This information would help public health agents balance the goals of cost recovery - which is necessary for a program to be self-sustaining - against the arguments for government subsidization of the program because of the externalities associated with the control of infectious disease. We estimate the demand for bednets based on a survey of over 250 house- holds in Tigray, an agricultural area characterized by seasonal, unstable malaria in the north of Ethiopia. At the time of our study, bednets
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Demandfor insecticide-treated mosquito nets 325 were essentially unknown to households in Tigray as a method of treating ma1aria.l The Tigray Region Malaria Control Department was considering ITNs as an intervention to decrease the risk of malaria and other diseases. To measure the demand for bednets, we asked the household head (or spouse) how many bednets he or she would purchase if they were avail- able. This modified stated preference method asked respondents to choose the quantity of goods they would purchase at a given price, rather than their willingness to pay for a fixed quantity of good. This modification permits estimation of the household demand for bednets. Given the supply price of ITNs, the demand curve can be used to calculate the subsidy nec- essary to guarantee that a certain fraction of the population is protected, assuming the bednets are sold as private goods.
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