East African Journal of Public Health Volume 1 Number 1 October 2004 18
WILLINGNESS TO PAY FOR ‘OLYSET’ BEDNETS AMONG FORMAL EMPLOYEES AND RURAL PEASANTS IN KOROGWE AND MUHEZA DISTRICTS, NORTHEASTERN TANZANIA
Godfrey M Mubyazi1, Vivien Barongo2, Kassembe Mdira2 and Kato J Njunwa3 Abstract
Owing to their impact on reducing mosquito nuisance, morbidity and mortality due to malaria, insecticide treated bednets Literature says that WTP in theory does not are promoted to be used at household level and in schools, military necessarily imply WTP in reality. WTP is defined as the camps, health facility wards, and guest houses. Nevertheless, the large-scale use of such materials is constrained by demand and maximum price that an individual is willing to dispose of supply factors. The contemporary debate is that people might be in order to obtain a product or service. The technique that willing to pay for bednets but their short supply could constrain their has popularly been used in the assessment of WTP is the actual use. Also it is concerned that supplying bednets in the market contingent valuation (4-6). According to Klose (6) the CV is one thing but whether people are prepared to purchase them is another thing since the actual uptake of bednets is determined by techniques employs the use of various questions including personal or household’s disposable income, and their prices, their open-ended, close-ended binary or close-ended shapes and sizes as well as people’s attitudes. polychotomous, bidding game, binary-with-follow-up as This paper reports on a study of willingness to pay (WTP) for well as polychotomous-with follow-up questions. The Olyset bednets among formal employees and villagers predominantly engaged in subsistence farming in Korogwe and Muheza districts in binary-with-follow-up and the bidding game techniques Tanzania. Generally, the study found that, fixing a price of Tshs. are the mostly recommended (7-8), although it is also 3,500 or more per one bednet to be paid at once is practically warned that most CV methods are still experimental, undesirable to many peasants even if the majority of them might therefore need for interpreting results cautiously becomes have had stated their WTP that price. On the other hand, allowing prepayments or payments by instalments has the advantage of obvious (9). This paper describes a mixture open-ended-, promoting sales and utilization of bednets among formal and close-ended polychotomous (without follow-up) and informal employees. The study recommends demand creation binary-with-follow-up questions applied in the elicitation mechanisms like social marketing towards changing public of WTP of people residing in three rural villages in perceptions and attitudes for better utilization of bednets. Korogwe and Muheza districts and formal employees Key Words: Willingness to pay, insecticide-treated nets, living in town centres of Muheza district in northeastern poverty, malaria, Tanzania Tanzania.
Background Materials and Methods
Estimates indicate that over 1,000,000 people in sub- Objectives, Study Areas and Populations Saharan Africa (SSA) die every year due to malaria, the mostly affected groups being children under the age of The study commenced in March 2001. Originally, the five years and pregnant women. Tanzania is one of SSA study was targeted to household members in rural villages, countries where malaria is highly endemic, statistics most of whom being employed in small-scale (mainly provided by the Ministry of Health (1) indicating that subsistence) farming. Initially, there were only 1000 100,000 die of malaria every year. Malaria has negative Olyset bednets available for this study that was targeted to impacts on the socio- economic development because of cover three villages. But it was decided later to extend the consequences associated with recurring episodes that study to formal employees after receiving a grant of 1000 reduces people’s ability to work, costs incurred on more bednets from Sumitomo Chemical Company of purchase of drugs, transport, admissions and funerals (in Japan. Among other objectives, the study was intended to: case of death) events. In recent years we have witnessed (i) assess the utilization of bednets at household level (ii) WHO/Roll Back Malaria, UNICEF national malaria compare individual respondents’ stated WTP with their control programs and other organizations increasing their actual WTP for Olyset bednets (iii) explore the alternative advocacy for insecticide treated bednets (ITBs) for the payment mechanisms for ITNs (but not specifically prevention of malaria. Nevertheless, the utilization rate of bednets) preferred by the respondents. The study was bednets in rural areas is reported to be as low as 10 - 20%. conducted in two malaria endemic districts – Korogwe and One of the barriers to bednets use is the low ability to pay Muheza (both located in Tanga Region) in northeastern and the low acceptability to majority of populations in Tanzania. The villages studied are Mkanyageni (Muheza SSA (2). It is believed that the problem of affordability District) and Mgombezi and Mazinde (Korogwe District). can be significantly reduced if payment mechanisms other The residents in these villages are mainly the Bondei (in than cash on delivery are explored (3). Also, Lines (2) Muheza) and Sambaa, Zigua and Pare (in Korogwe). The argues that, utilization of bednets for malaria prevention main crops grown in both districts are maize, rice, maize, purposes can be enhanced through various promotion cassava, rice, potatoes, oranges and coconut, and rainfall strategies. It has been observed that, the use of ITBs can ranges from slightly less than 1200mm annually to reduce malaria transmission to a remarkable degree as 3000mm in a few areas. Both district have a tarmac road opposed to over-reliance on chemotherapy that seems to connecting the district capital with neighboring regions of be inefficient in malaria control. Kilimanjaro and Dar Es Salaam, but most of the rural roads are dusty and become muddy and sleepy during rain Correspondence to: Godfrey M Mubyazi, P. O. Box 81, Muheza, Tanga, Tanzania. seasons. By the time of study was started, estimates made based on previous small-scale community surveys, 1Dept. of Health Systems and Policy Researc h, 2NIMR Ubwari Research Station Muheza, 3Kigali Health Institute, Rwanda indicated that the rate of bednets use in Muheza District was <10% of all households in villages (Caroline East African Journal of Public Health Volume 1 Number 1 October 2004 19
Maxwell, Kato Njunwa & Chris Curtis, person required. Interview was just held with 59 NIMR staff (24 communication), and was considered to be the same in at Ubwari Research Station and 35 at Amani Centre). Korogwe District. Similarly, seven staff at the NMB responded to the interview. But as the high malaria season was already Sampling confronted, the research team experienced increased requests from employees who were insisting to be Village Study provided with the bednets first and then the interview to come thereafter. Coincidently, some of the trained The three villages studied were strategically selected, interviewers were not around to conduct interviews by that classified as ‘rural’ but located very far from each other. moment due to other official commitments. Therefore, The decision to choose two villages in Korogwe district interviews were waived and bednets were provided on and only one in Muheza district was made because loan basis to those who requested. This was done in Korogwe had so far experienced fewer studies related to consideration that the questionnaire would be modified bednets than Muheza where researchers from the MRC and applied later to take a retrospective approach for (UK e.g. Maxwell and Curtis) and from the National assessing why those who took the nets were attracted to Institute For Medical Research (NIMR) – Amani Centre such nets and the maximum WTP price they preferred per have been operating for a number of years. During the net apart from the Tshs. 3000 that was subsidized by the baseline survey in each village, 416 households were project and commonly charged to everyone who required randomly selected whereby one head (either a male or them. female) or their representatives were interviewed. The As time went on, the provision of bednets was not assumption was that about, based on the baseline data on restricted to staff only, but also it involved their the estimated rate of bednets use (<10%) at village level relatives/family members as almost all of the staff and initially 1000 bednets available for the study, an presented a request to have a relative or several of them average of 330 bednets would be purchased per study who also were in need of such bednets. In general, 65 staff village. Although the target was to interview 140 heads of at Amani Medical Research Centre were provided with households per village, in total the householders bednets as per their WTP. Also, in February 2003, the interviewed were: Mazinde (141), Mgombezi (135), and Muheza Police staff community took 5 boxes each Mkanyageni (140). In addition, 3 focus group discussions containing 20 bednets that were shared among 100 (FGDs) were held in each village with selected members individual police staff. Also, the police agreed to take of households (but not those already interviewed bednets according to their needs so that they could pay individually). The baseline phase also interviewed 71 later in one or two monthly instalments through their retail shop/kiosk keepers on ITBs sales and utilization salaries after which they could be interviewed. This aspects. The information collected from households during agreement was reached during a general staff meeting that the baseline phase (for those who stated to be willing to was attended by the principal investigator and one of his pay) provided the basis for selecting a number of research team staff, both of whom were invited to respond respondents who were followed-up later to confirm their to some questions relating to the use of such bednets, their WTP in actual sense. Also, it provided the basis for protective efficacy and their side-effects (if any). The identifying sales agents (shops) where the study bednets meeting was also attended by the district’s police-officer- came to be supplied so that those willing to buy them at in-charge (OCD), the Station Police in-charge and other their own time could do it as conveniently as possible, as police officers. suggested by the majority of the residents interviewed. The follow-up phase adopted a systematic random Data Collection Methods sampling method to arrive at 26 households out of a total number of (140) household respondents in each village Heads of households, shopkeepers and formal who hypothetically stated to be willing to pay for the employees were interviewed using a semistructured bednets at the stated price of Tshs. 3,500 per one net. The questionnaire administered by the researchers. It had a selection 10 shops who later on acted as agents for retail series of questions (based on experience from the pilot selling of the study bednets during the intervention phase survey) with pre-coded answers some of which were was made in consultation with the ward and village binary, close-ended polychotomous, and others being government leaders and involved the shop/kiosk-keepers open-ended. There was slight difference in the concerned. A similar net approach was used in the KINET formulations of the questions applied between formal Project in Kilombero. employees and shopkeepers. Focus group discussions (FGDs) were held (each comprising of 6-12 participants). Formal employees study To avoid people expressing their WTP blindly for a product they don’t see or know, there was a scenario for As time went on while the study was ongoing, the showing and demonstrating (to different types of research team realized formal employees had interest in respondents) the use of the Olyset bednet, and explanation Olyset bednets. Of these employees, some belonged to given regarding its potential benefits and disadvantages. NIMR, particularly at the Amani Centre, others worked at The mostly explained benefit was the efficacy of the the National Micro-finance Bank (NMB)- Muheza Branch, insecticide contained in the fabrics, the durability of the and some police at the Muheza Town Police Station. It nylon fabrics if carefully used, and its potential for saving was expected that, all these would be interviewed about lives and reduction in economic costs such as expenditures their WTP before they could be offered the nets they on drugs or short-lived mosquito-coils for those opting to East African Journal of Public Health Volume 1 Number 1 October 2004 20 use such products. The disadvantage mainly identified was Table 2: Baseline suggestions by shopkeepers about the the smell of the insecticide especially in the initial days of price per one Olyset net under study in Three the bednet’s use and the re-treatment costs after (though Villages long) while. A similar scenario was applied in Nigeria. While in FGDs the question concerning how much people Name of Mean Price Median Modal Stated Price Village Price Price Ranges would afford to pay per a bednet was left open to be discussed by the participants themselves, for the Mkanyageni Tshs. 2,775 Ths. 3000 Tshs. 3000 Tshs. 1500– 3500 (US $ 2.9) US $3.1) (US $ 3.1) (US $1.6 – 3.7) household heads and some staff a hypothetical price of Tanzanian Shillings (Tshs.) 3,500/= for a medium-sized (4 Mgombezi Tshs. 2,500 Tshs. 3000 Tshs. 3000 Tshs. 1500– 3000 (US $ 2.6) US $ 3.1) (US $ 3.1) (US $ 1.6 – 3.7) by 6 feet) square bednet was used in the elicitation. This Mazinde Tshs. 3010 Tshs. 2,250 Tshs. 3000 Tshs. 1000– 4500 price was determined based on the research team (US $ 3.2) (US $ 2.4) (US $ 3.1) (US $ 1 – 4.7) consulting community leaders and local retail shopkeepers as key informants. The next step the research team made Local government leaders in Mazinde village viewed was to supply bednets to each shop selected to work to that bednets would be affordable to the majority of the shops as study agent for assessing the trend of bednets residents if the price per net ranged between Tshs. 2000 – sales at different seasons of the year. Between late March 3500. They initially suggested of Tshs. 4,500 – 5,000 but and early August, 440 bednets were distributed as follows: this came to be seen as being too high. Their fellows in 140 nets in 4 shops (Mazinde), 150 nets in 3 shops Mgombezi Village proposed a price range of Tshs. 2,500 – (Mgombezi) and 150 nets in 3 shops (Mkanyageni). A 4,000 while those in Mkanyageni Village suggested Tshs. special short questionnaire was prepared to guide the net 1,500 – 2,500 per one bednet. With regard to the best shop/kiosk keepers to record some information from all period in which bednets would be highly purchasable, individual persons who visited their outlets for the purpose such community leaders in Mkanyageni village viewed the of buying the nets. rain season when mosquito densities are high or during crop harvest season when cash income is easily accessible Results to the majority of households. Their fellow leaders in Mazinde shared the same view, although they warned that From the Baseline Survey during rain season nets would not be bought if the price per net exceeded Tshs. 2,500. Similarly, leaders in Concerning the desirable price per net Mgombezi village supported the crop harvest season on ground that during the rain season when early stages of From the open-ended question, individual crop cultivation such as farm preparation and weeding shopkeepers suggested different prices. There were take place, it is difficult for most of the rural residents to absolutely different prices suggested by respondents of access cash because the little cash they have is spent on different villages, as shown in Table 1. buying fertilizers, pesticides, and food (because of having little or none in the stock by that time). Table 1: Different levels of Prices as suggested by As for FGD participants, who were categorized into different numbers of shopkeepers in the Three three groups of adult men (aged 36+ years), young men Villages studied (aged 18-35 years) and women (of childbearing age) in each village, the following table reveals the opinions Price Level (in Village Names Tshs.) collected regarding the most affordable price ranges Mazinde Mgombezi Mkanyageni suggested by individual groups of participants:
<2000 1 2.7% 1 5.9% 1 6.25% 4.2% Table 3. Price ranges (in Tshs.) per one Olyset Bednet as 2001 – 2500 13 35.1% 9 52.9 4 25.0% 36.6% % suggested by the majority of the FGD participants 2501 – 3000 10 27.0% 6 35.3 11 68.75% 52.1% % Age and Sex Group Mazinde Mgombezi Mkanyagen 3001 – 3500 8 21.6% 1 5.9% 0 0% 12.7% (Korogwe) (Korogwe) i (Muheza )
3501 – 4000 3 8.1% 0 0% 0 0% 4.2% Young men (18-35years) 2000-4000 2000-2500 2000-2500 4001 – 4500 1 2.7% 0 0% 0 0% 1.4% Adult men (36 years+) 2000-2500 2000-5000 2000 4501 - 5000 1 2.7% 0 0% 0 0% 1.4% All women (15 years+) 2000 2000 2500-5000 Total 37 100% 17 100% 16 100% 100% Respondents A few participants suggested a price less than those suggested by the majority of their fellow discussants in the From Table 1 it can be seen that the mean, median, mode groups. For instance, in Mazinde, some participants and range of prices suggested by shopkeepers in each suggested a price range of Tshs. 1000 – 1,500 while a few study village were as follows: who realized the protective efficacy of ITNs as compared to untreated bednets proposed a price even higher than those suggested by the majority of the discussants in their individual groups. From a total of 416 household members who responded to be interviewed, the mean, modal and median family sizes were all (6) while mean and median ages of the respondents were 42 and 39 years respectively. Of all East African Journal of Public Health Volume 1 Number 1 October 2004 21 the households 320 (76.9%) were headed by men, Figure 2. WTP for Olyset Nets if the Price Per One were a meanwhile 312 (75%) of the total respondents were little
33. interested customers was greatly discouraged by retail 35.00% 30% shop/kiosk sellers, although some FGD participants 23. s 30.00% t 60% n .
40% seemed to be in support of that. 25.00% 6 . 1 5 1 nde 20.00%
o 90% p
s 15.00% 7. 70% 90% e From the Follow-Up [Intervention] Phase 0. 2.
R 10.00% l l 5.00% A
% 0.00% The trend of bednets sales at the study agent shops n i a 999 999 t 1 2999 3999 4999
0- was quite discouraging. Notably there was no significant 5000+ cer n 000- 1 2000- 3000- 4000-
U variation in bednets sales between the rain and dry Price Rates seasons. In all the three villages, the highest bednets sales were noticed during May, followed by June, as shown in
Table 4: Number of bednets household respondents were Table 5: Trend of Olyset bednets sales at shops selected WTP if the price per net were Tshs. 3,500 as agents to our project during year 2001 in three study villages in Korogwe and Muheza Number of Bednets Proportion (%) of Districts Respondents 1 21.6 Month Villages and Nets Sold 2 14.2 (Year 2001) Mkanyageni Mgombezi Mazinde Total 3 3.1 March 3 0 2 5 4 1.9 April 8 3 7 18 May 12 20 12 44 5+ 0.5 June 10 6 11 27 0 52.4 July 4 4 6 14 Uncertain (?) 6.3 Total 37 33 38 108
Householders’ WTP based on a binary with follow-up (BWFU) question
Up to the end of the study, the total number of household respondents who were followed-up to elicit their true WTP was 26 in each village whereby the East African Journal of Public Health Volume 1 Number 1 October 2004 22 composition of males and female respondents was as At Amani Centre (located in the East Usambara follows: Mkanyageni (15 men, 11 women); Mgombezi (11 Mountains) 40 staff came for the second time thereby men, 15 women); Mazinde (10 men, 16 women). But none taking 120 bednets (average of 3 bednets per staff). Those of the respondents were able to pay even for a single who came for the bednets for the second time at Ubwari bednet in actual sense as was anticipated. Some of them Station in Muheza Town (in the lower parts of the (11, 12, and 19 in the each village respectively) were not mountains, about 35 km from Amani) 42 staff took a total even found at home on the first day the follow up was of 147 bednets (also, average of 3 bednets per staff). Of made. The researchers had to set new appointments by such 42 staff at Ubwari Station, 13 (31%) were able to pay leaving information with relatives who were found at part of their loan. home. Despite efforts to make more follow-up visits to trace those who were missed, no changes were noticed for Police Staff at Muheza District Police Station and none came to actually pay for the nets. It was recognized NMB Staff in Muheza later that it was difficult to trace some of our respondents because they deliberately gave us fake (improper) names The 7 staff at the National Micro-finance Bank during the baseline survey. Consulting local key (NMB) were able to pay on the spot as they promised informants as to why that was the case, it was revealed during the interview. On average, each NMB staff took 3 that, this event was mainly due to fear by such respondents bednets at a price of Tshs. 3,000. Similarly, all the 100 of feeling ashamed if they were found with no money as bednets that were supplied to the Police Station were taken they promised on the dates of appointment they would be by 100 police staff households (i.e. 1 bednet per each followed-up by the researchers. household) at a price of Tshs. 3,000 per net, and the whole amount of Tshs. 300,000 was collected in May 2003 from NIMR staff at Amani Medical Research Centre in the OCD’s office at the Police Station. Muheza Discussion All the 24 staff initially interviewed about their WTP at the NIMR - Ubwari Station (in Muheza Town) and 5 The methodological approach used in the elicitation staff at Bombo NIMR Station (in Tanga Municipality) of WTP and the findings from interviews and discussions stated to be willing to pay. The poor trend of bednets sales held with various respondents provide ground for debate if in villages prompted the research team to rethink and fix a one has to say exactly that this or that was the most price of Tshs. 3,000 per net in order to attract more staff to appropriate (affordable and desirable) price per one Olyset buy without regarding their employment status. Also, this type of bednet. It can be seen that the majority of the was purposely done in conformity to the demand theory respondents of different categories were in favour of a that the lower the price the higher the quantity demanded, price of less than or equal to Tshs. 3000 per net. The ceteris paribus. This was also due to the observation that fixing of Tshs. 3,500 per bednet made by the research most of the respondents both in FGDs and household team based on advice from shopkeepers and local interviews had preferred to pay between Tshs. 2000 - community leaders seems to have gone beyond the 3000. The number of bednets actually taken by each staff expectations and suggestions of the majority of the ranged between 1- 6. The modal number of bednets that residents interviewed. In this case, it is evident that it is the staff were willing to buy and, which they actually paid-for consumer who should be sovereign i.e. who has to be was 2. The mean and median actual WTP price for the listened more in order to make appropriate judgment of nets was automatically Tshs. 3,000 equal to the fixed price best price to be paid per the bednet. It also sounds good to per bednet. More than a half of the staff suggested to be use multiple techniques and sources of evidence in given nets on loan basis so that they could be able to assessing WTP for products like bednets, but the limitation recover their debts through their monthly salaries that is that, it may be difficult to judge at the end of the day could be officially deducted in one or two monthly whose opinion or which study technique maximizes the instalments depending on the number of bednets one opted reliability of information with regard to the most desirable to take. Those who agreed with this proposal were (widely acceptable and affordable) WTP price. registered their names after which they were given the Findings from individual household respondents had bednets. To ensure that the money would be effectively shown that a considerable proportion of the respondents collected, the project managers liaised with the NIMR stated to be willing to pay in response to a hypothetical Amani Centre Finance and Administration Department question on WTP if the price were Tshs. 3500. But none of through the Director who authorized staff salaries to be those who were followed-up to see whether they could deducted as per agreement, and the money for the first actually take the nets by paying that sum of money in light instalment was deducted in April 2003 from their salaries. of their promises, actually paid. Again, this provides A few of the staff paid on the spot (either for some or all evidence that WTP hypothetically does not necessarily the bednets they decided to take) immediately after being reflect one’s true WTP. interviewed. Interestingly, some of the staff returned one As in other businesses, data from staff working in or two days later with new requests for additional bednets different organizations reveals that selling bednets on loan after having used the nets they were given one day or basis is one effective ways through which such materials several days before. At the Amani Centre, a total of 65 can be promoted for their actual utilization at household initially registered for bednets actually took the bednets on and other community levels. This form of business either loan basis. The total number of bednets taken was 219, allows the potential customers to take the bednets in thus showing an average of 3 bednets taken by each staff. advance of payment and come to pay the whole amount East African Journal of Public Health Volume 1 Number 1 October 2004 23 later or to pay little at a time until they complete the total concluded that, most Tanzanians especially those living in amount required before they could be given the bednets. rural areas, fixing a price exceeding Tshs. 3,000 per net is The underlying challenge to latter option is that, few highly undesirable (unless initial sensitization such as people (if any) especially in developing communities like social marketing is instituted) and it is likely to reduce the those studied have little trust in disposing their money in prospects of the going to national scale with ITNs, which advance of getting the commodity while they know that is the current strategy of the Tanzanian National Malaria they might be forgoing the money required for other Control Program. However, free-of-charge bednets essential needs. provision not only opens the debate about who will Various inferences can be drawn as to why some staff provide such materials and who will bear the costs, but requested for additional bednets after they had been also could be crowd-out some bednets manufacturers and interviewed and given the first number of bednets they traders and intensifies the debate about the sustainability stated to be WTP for, given the price. Possibly, the loan of such a public health policy advocacy. granted motivated them if at all it is not the quality of the nylon material that indicates a high degree of the bednets Acknowledgments durability (for most poor households would prefer products that have a long lasting quality). The other Thanks be given to Mr. Hasnein Gulamhussein, the quality things that might have had motivated them are the representative of the Sumitomo Chemical Company, repellent and killing effects they might had seen after country office-Dar Es Salaam, Tanzania, through whom using the bednets for sometime. Probably, had the we have been able to request and obtain additional 1000 villagers also been given such an opportunity for buying nets to the previous ones (1000) donated by the same bednets on a loan term for them to pay by instalment, a company, the Sumitomo Chemical Company in Japan. We similar motivation would be realized. However, the are grateful to our study respondents and the district problem could arise in terms of making follow up to central and local government officers in Korogwe and collect the money since for rural residents (particularly Muheza districts, Tanzania for their cooperation during peasants), the issue of cash unreliability would be reported this study. The assistants in data collection (Mayunga even if people were given more time. Mayega; Mujuni Njunwa, Dorica Mubyazi; Judith Mahundi; Hamza Mohamed, Dr. Samuel Gesase) are also Conclusion and public health policy implications thanked for their active participation. The Director of Amani Centre and Mr. Julius Mhina, also of NIMR-Amani Application of multiple methods in the assessment of Centre are also thanked for providing support on the community WTP is vital if more reliable information has coordination this one type of the ENRECA supported to be established to understanding the most desirable price project. This study was funded collaboratively by to guide dealers in bednets business or bednets related DANIDA that provided a grant of Tshs. 10,000 for malaria interventions. Nevertheless, it is important to fieldwork and the Sumitomo Chemical Company of Japan recognize that different techniques may yield diverse that provided 2000 Olyset bednets for study free of charge results that are too difficult to reconcile so as to come up for research purposes. with one justifiable conclusion for policy action. One possibility could be to apply systematically one or two References techniques and test them, and should it reveals considerable shortcomings, then an alternative approach 1. Ministry of Health, Tanzania (2000). National guidelines for malaria diagnosis and treatment (Malaria Control Series 2000). Ministry of Health, Dar es can be adopted. Testing one or at most two elicitation Salaam, 2000. 2. Lines J.D.(1996): Mosquito nets and insecticides for net treatment: a techniques at a time can be easily manageable and provide discussion of existing and potential distribution systems in Africa. Tropical greater feasibility for analysis. Meanwhile it is important Medicine and International Health Vol. 1 (5) 616 - 632 October 1996 3. Mujinja, P.G.M. and Premji, Z. (1998). Willingness to pay for insecticide to recognize that a person’s or community’s WTP might treated bed nets for malaria control: A case study for Bagamoyo Bednet change over time, especially when there is changes in Project. Paper presented at the MIM Malaria Conference, 14 - 19 March, 1999, Durban, South Africa. other domain demand factors like consumer’s disposable 4. Russell, S (1996). Ability to Pay for Healthcare: concepts and evidence. Health income, preferences and expectations about the product in Policy and Planning 11 (3): 219-237 5. Russell, S., Fox-Rushby, J and Arhin, D (1995). Willingness and Ability to Pay question that also might depend on time and market for health care: a selection of methods and issues. Health Policy and Planning situations. As malaria preventive services are advocated 10 (1) 94 – 101. 6. Klose T (1999). The contingent valuation method in health care. Health Policy for being oriented to communities with limited access, the 1999; 47: 97-123. need for continued collection of opinions from 7. Johannesson, M., Liljas B., and Johansson P (1998). Experimental comparison of dichotomous choice contingent valuation and real purchase decisions. communities of different characteristics remains essential, Applied Econom 30: 643-647. and one way to ensure this is accomplished in terms of 8. Johannesson M., Liljas B., and O’Connor (1997). Hypothetical versus real willingness to pay: some experimental results. Applied Econom Letts 4: 149-151 bednets is to continue supporting WTP and actual 9. Donaldson C et al. (1997). Assessing community values in healthcare: Is the utilization studies on bednets, especially as the willingness to pay method feasible? Healthcare Analysis Vol. 5 (1): 7-29 government is working to moving to a national scale with ITNs. Based on findings from different respondents and the trend of bednets sales in the study villages, it is