Abstract
BackgroundExpanding access to long-lasting insecticidal nets (LLINs) is difficult if one is limited to government and donor financial resources. Private commercial markets could play a larger role in the continuous distribution of LLINs by offering differentiated LLINs to middle-class Ghanaians. This population segment has disposable income and may be willing to pay for LLINs that meet their preferences. Measuring the willingness-to-pay (WTP) for LLINs with specialty features that appeal to middle-class Ghanaians could help malaria control programmes understand what is the potential for private markets to work alongside fully subsidized LLIN distribution channels to assist in spreading this commodity.MethodsThis study conducted a discrete choice experiment (DCE) including a real payment choice among a representative sample of 628 middle-income households living in Ashanti, Greater Accra, and Western regions in Ghana. The DCE presented 18 paired combinations of LLIN features and various prices. Respondents indicated which LLIN of each pair they preferred and whether they would purchase it. To validate stated willingness-to-pay, each participant was given a cash payment of $14.30 (GHS 65) that they could either keep or immediately spend on one of the LLIN products.ResultsThe households’ average probability of purchasing a LLIN with specialty features was 43.8% (S.D. 0.07) and WTP was $7.48 (GHS34.0). The preferred LLIN features were conical or rectangular one-point-hang shape, queen size, and zipper entry. The average WTP for a LLIN with all the preferred features was $18.48 (GHS 84). In a scenario with the private LLIN market, the public sector outlay could be reduced by 39% and private LLIN sales would generate $8.1 million ($311 per every 100 households) in revenue in the study area that would support jobs for Ghanaian retailers, distributors, and importers of LLINs.ConclusionResults support a scenario in which commercial markets for LLINs could play a significant role in improving access to LLINs for middle-income Ghanaians. Manufacturers interested could offer LLIN designs with features that are most highly valued among middle-income households in Ghana and maintain a retail price that could yield sufficient economic returns.
Highlights
Expanding access to long-lasting insecticidal nets (LLINs) is difficult if one is limited to government and donor financial resources
The majority of the study population believed that malaria is not easy to treat, that insecticide-treated nets are effective and that it is easier to get a good night sleep when sleeping under a bed net
Results indicate that individual characteristics, such as living in a rural area, being male, being less wealthy and living in the Ashanti Region were associated with higher LLIN demand
Summary
Expanding access to long-lasting insecticidal nets (LLINs) is difficult if one is limited to government and donor financial resources. Private commercial markets could play a larger role in the continuous distribution of LLINs by offering differentiated LLINs to middle-class Ghanaians. This population segment has disposable income and may be willing to pay for LLINs that meet their preferences. One of the most cost-effective strategies for reducing the global malaria burden is sleeping under longlasting insecticidal bed nets (LLINs). (DALY) averted [1, 2] They are effective even in areas with mosquito resistance to insecticides [3]. Between 2010 and 2016, the proportion of people at risk of malaria in Africa sleeping under an insecticide-treated net (ITN), including LLINs, increased from 30 to 54% [4]. Multiple strategies will be required to grow more coverage including mass free net distribution campaigns and the growth of new and under-utilized channels, such as commercial sector channels [5]
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