Willingness to Pay for 'Olyset' Bednets Among Formal Employees and Rural
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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.