Skip to main content
Top
Published in: Malaria Journal 1/2020

01-12-2020 | Malaria | Research

Willingness-to-pay for long-lasting insecticide-treated bed nets: a discrete choice experiment with real payment in Ghana

Authors: Y. Natalia Alfonso, Matthew Lynch, Elorm Mensah, Danielle Piccinini, David Bishai

Published in: Malaria Journal | Issue 1/2020

Login to get access

Abstract

Background

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. 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.

Methods

This 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.

Results

The 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.

Conclusion

Results 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.
Appendix
Available only for authorised users
Literature
1.
go back to reference White MT, Conteh L, Cibulskis R, Ghani AC. Costs and cost-effectiveness of malaria control interventions—a systematic review. Malar J. 2011;10:337.CrossRef White MT, Conteh L, Cibulskis R, Ghani AC. Costs and cost-effectiveness of malaria control interventions—a systematic review. Malar J. 2011;10:337.CrossRef
2.
go back to reference WHO. Achieving and maintaining universal coverage with long-lasting insecticidal nets for malaria control. Geneva: World Health Organization; 2017. WHO. Achieving and maintaining universal coverage with long-lasting insecticidal nets for malaria control. Geneva: World Health Organization; 2017.
3.
go back to reference WHO. Implications of insecticide resistance for malaria vector control. Geneva: World Health Organization; 2016. WHO. Implications of insecticide resistance for malaria vector control. Geneva: World Health Organization; 2016.
4.
go back to reference WHO. World malaria report 2017. Geneva: World Health Organization; 2017. WHO. World malaria report 2017. Geneva: World Health Organization; 2017.
5.
go back to reference Theiss-Nyland K, Lynch M, Lines J. Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa. Malar J. 2016;15:255.CrossRef Theiss-Nyland K, Lynch M, Lines J. Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa. Malar J. 2016;15:255.CrossRef
6.
go back to reference Alonso P, Noor AM. The global fight against malaria is at crossroads. Lancet. 2017;390:2532–4.CrossRef Alonso P, Noor AM. The global fight against malaria is at crossroads. Lancet. 2017;390:2532–4.CrossRef
7.
go back to reference WHO. Global Technical Strategy for Malaria 2016–2030. Geneva: World Health Organization; 2015. WHO. Global Technical Strategy for Malaria 2016–2030. Geneva: World Health Organization; 2015.
8.
go back to reference Patouillard E, Griffin J, Bhatt S, Ghani A, Cibulskis R. Global investment targets for malaria control and elimination between 2016 and 2030. BMJ Global Health. 2017;2:e000176.CrossRef Patouillard E, Griffin J, Bhatt S, Ghani A, Cibulskis R. Global investment targets for malaria control and elimination between 2016 and 2030. BMJ Global Health. 2017;2:e000176.CrossRef
9.
go back to reference Nonvignon J, Aryeetey GC, Malm KL, Agyemang SA, Aubyn VNA, Peprah NY, et al. Economic burden of malaria on businesses in Ghana: a case for private sector investment in malaria control. Malar J. 2016;15:454.CrossRef Nonvignon J, Aryeetey GC, Malm KL, Agyemang SA, Aubyn VNA, Peprah NY, et al. Economic burden of malaria on businesses in Ghana: a case for private sector investment in malaria control. Malar J. 2016;15:454.CrossRef
10.
go back to reference Comfort AB, Krezanoski PJ. The effect of price on demand for and use of bednets: evidence from a randomized experiment in Madagascar. Health Policy Plan. 2017;32:178–93.PubMed Comfort AB, Krezanoski PJ. The effect of price on demand for and use of bednets: evidence from a randomized experiment in Madagascar. Health Policy Plan. 2017;32:178–93.PubMed
11.
go back to reference Tarozzi A, Mahajan A, Blackburn B, Kopf D, Krishnan L, Yoong J. Micro-loans, insecticide-treated bednets, and malaria: evidence from a randomized controlled trial in Orissa, India. Am Econ Rev. 2014;104:1909–41.CrossRef Tarozzi A, Mahajan A, Blackburn B, Kopf D, Krishnan L, Yoong J. Micro-loans, insecticide-treated bednets, and malaria: evidence from a randomized controlled trial in Orissa, India. Am Econ Rev. 2014;104:1909–41.CrossRef
12.
go back to reference Gingrich CD, Ricotta E, Kahwa A, Kahabuka C, Koenker H. Demand and willingness-to-pay for bed nets in Tanzania: results from a choice experiment. Malar J. 2017;16:285.CrossRef Gingrich CD, Ricotta E, Kahwa A, Kahabuka C, Koenker H. Demand and willingness-to-pay for bed nets in Tanzania: results from a choice experiment. Malar J. 2017;16:285.CrossRef
13.
go back to reference Kochhar R. A global middle class is more promise than reality: from 2001 to 2011, nearly 700 million step out of poverty, but most only barely. Washington, D.C: Pew Research Center; 2015. Kochhar R. A global middle class is more promise than reality: from 2001 to 2011, nearly 700 million step out of poverty, but most only barely. Washington, D.C: Pew Research Center; 2015.
14.
go back to reference Adamowicz W, Boxall P, Williams M, Louviere J. Stated preference approaches for measuring passive use values: choice experiments and contingent valuation. Am J Agric Econ. 1998;80:64–75.CrossRef Adamowicz W, Boxall P, Williams M, Louviere J. Stated preference approaches for measuring passive use values: choice experiments and contingent valuation. Am J Agric Econ. 1998;80:64–75.CrossRef
15.
go back to reference Johnson FR, Lancsar E, Marshall D, Kilambi V, Mühlbacher A, Regier DA, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value Health. 2013;16:3–13.CrossRef Johnson FR, Lancsar E, Marshall D, Kilambi V, Mühlbacher A, Regier DA, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value Health. 2013;16:3–13.CrossRef
16.
go back to reference WHO. World malaria report 2018. Geneva: World Health Organization; 2018. WHO. World malaria report 2018. Geneva: World Health Organization; 2018.
17.
go back to reference Ghana Statistical Service (GSS). Ghana Living Standards Service Round 6. 2014. Ghana Statistical Service (GSS). Ghana Living Standards Service Round 6. 2014.
18.
go back to reference Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF. Ghana Malaria Indicator Survey 2016. Accra, Ghana, and Rockville, Maryland, USA: GSS, GHS, and ICF; 2017. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF. Ghana Malaria Indicator Survey 2016. Accra, Ghana, and Rockville, Maryland, USA: GSS, GHS, and ICF; 2017.
19.
go back to reference Ghana Statistical Service (GSS). Ghana Poverty Mapping Report. 2015. Ghana Statistical Service (GSS). Ghana Poverty Mapping Report. 2015.
20.
go back to reference Mensah E, Piccinini D, Osei T, Dontoh A, Kim S, Alfonso YN. Catalyzing the commercial market for LLINs in Ghana, a market analysis. URIKA Research and PSMP project; 2018. Mensah E, Piccinini D, Osei T, Dontoh A, Kim S, Alfonso YN. Catalyzing the commercial market for LLINs in Ghana, a market analysis. URIKA Research and PSMP project; 2018.
21.
go back to reference Louviere J, Hensher D, Swait J. Stated choice methods analysis and application. Cambridge: Cambridge University Press; 2000.CrossRef Louviere J, Hensher D, Swait J. Stated choice methods analysis and application. Cambridge: Cambridge University Press; 2000.CrossRef
22.
go back to reference Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making. PharmacoEconomics. 2008;26:661–77.CrossRef Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making. PharmacoEconomics. 2008;26:661–77.CrossRef
23.
go back to reference Bridges JFP, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, et al. Conjoint analysis applications in health—a checklist: a report of the ISPOR good research practices for conjoint analysis task force. Value Health. 2011;14:403–13.CrossRef Bridges JFP, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, et al. Conjoint analysis applications in health—a checklist: a report of the ISPOR good research practices for conjoint analysis task force. Value Health. 2011;14:403–13.CrossRef
24.
go back to reference Adams J, Bateman B, Becker F, Cresswell T, Flynn D, McNaughton R, et al. Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment. Health Technol Assess. 2015;19:1–76.CrossRef Adams J, Bateman B, Becker F, Cresswell T, Flynn D, McNaughton R, et al. Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment. Health Technol Assess. 2015;19:1–76.CrossRef
25.
go back to reference Carlsson F, Martinsson P. Design techniques for stated preference methods in health economics. Health Econ. 2003;12:281–94.CrossRef Carlsson F, Martinsson P. Design techniques for stated preference methods in health economics. Health Econ. 2003;12:281–94.CrossRef
26.
go back to reference Louviere JJ, Hout M. Analyzing decision making: Metric conjoint analysis. Thousand Oaks: Sage; 1988.CrossRef Louviere JJ, Hout M. Analyzing decision making: Metric conjoint analysis. Thousand Oaks: Sage; 1988.CrossRef
27.
go back to reference Moser R, Raffaelli R, Notaro S. Testing hypothetical bias with a real choice experiment using respondents’ own money. Eur Rev Agric Econ. 2014;41:25–46.CrossRef Moser R, Raffaelli R, Notaro S. Testing hypothetical bias with a real choice experiment using respondents’ own money. Eur Rev Agric Econ. 2014;41:25–46.CrossRef
28.
go back to reference Louviere JJ, Woodworth G. Design and analysis of simulated consumer choice or allocation experiments: an approach based on aggregate data. J Mark Res. 1983;20:350–67.CrossRef Louviere JJ, Woodworth G. Design and analysis of simulated consumer choice or allocation experiments: an approach based on aggregate data. J Mark Res. 1983;20:350–67.CrossRef
29.
go back to reference Aizaki H, Nishimura K. Design and analysis of choice experiments using R: a brief introduction. Agricult Inform Res. 2008;17:86–94.CrossRef Aizaki H, Nishimura K. Design and analysis of choice experiments using R: a brief introduction. Agricult Inform Res. 2008;17:86–94.CrossRef
30.
go back to reference Yukich JO, Briët OJT, Ahorlu CK, Nardini P, Keating J. Willingness to pay for small solar powered bed net fans: results of a Becker–DeGroot–Marschak auction in Ghana. Malar J. 2017;16:316.CrossRef Yukich JO, Briët OJT, Ahorlu CK, Nardini P, Keating J. Willingness to pay for small solar powered bed net fans: results of a Becker–DeGroot–Marschak auction in Ghana. Malar J. 2017;16:316.CrossRef
31.
go back to reference Aleme A, Girma E, Fentahun N. Willingness to pay for insecticide-treated nets in Berehet District, Amhara Region, Northern Ethiopia: implication of social marketing. Ethiop J Health Sci. 2014;24:75–84.CrossRef Aleme A, Girma E, Fentahun N. Willingness to pay for insecticide-treated nets in Berehet District, Amhara Region, Northern Ethiopia: implication of social marketing. Ethiop J Health Sci. 2014;24:75–84.CrossRef
32.
go back to reference Onwujekwe O, Hanson K, Fox-Rushby J. Inequalities in purchase of mosquito nets and willingness to pay for insecticide-treated nets in Nigeria: challenges for malaria control interventions. Malar J. 2004;3:6.CrossRef Onwujekwe O, Hanson K, Fox-Rushby J. Inequalities in purchase of mosquito nets and willingness to pay for insecticide-treated nets in Nigeria: challenges for malaria control interventions. Malar J. 2004;3:6.CrossRef
33.
go back to reference Breidert C, Hahsler M, Reutterer T. A review of methods for measuring willingness-to-pay. Innovative Marketing. 2006;2:8–32. Breidert C, Hahsler M, Reutterer T. A review of methods for measuring willingness-to-pay. Innovative Marketing. 2006;2:8–32.
34.
go back to reference Dupas P. Short-run subsidies and long-run adoption of new health products: evidence from a field experiment. Econometrica. 2014;82:197–228.CrossRef Dupas P. Short-run subsidies and long-run adoption of new health products: evidence from a field experiment. Econometrica. 2014;82:197–228.CrossRef
35.
go back to reference Cohen J, Dupas P. Free distribution or cost-sharing? Evidence from a randomized malaria prevention experiment. Q J Econ. 2010;125:1–45.CrossRef Cohen J, Dupas P. Free distribution or cost-sharing? Evidence from a randomized malaria prevention experiment. Q J Econ. 2010;125:1–45.CrossRef
36.
go back to reference Jack W. The demand for health care services. Principles of health economics for developing countries. Washington: The World Bank; 1999. p. 55–90. Jack W. The demand for health care services. Principles of health economics for developing countries. Washington: The World Bank; 1999. p. 55–90.
37.
go back to reference Nghiem N, Wilson N, Genç M, Blakely T. Understanding price elasticities to inform public health research and intervention studies: key issues. Am J Public Health. 2013;103:1954–61.CrossRef Nghiem N, Wilson N, Genç M, Blakely T. Understanding price elasticities to inform public health research and intervention studies: key issues. Am J Public Health. 2013;103:1954–61.CrossRef
38.
go back to reference Loureiro ML, Umberger WJ, Hine S. Testing the initial endowment effect in experimental auctions. Appl Econ Lett. 2003;10:271–5.CrossRef Loureiro ML, Umberger WJ, Hine S. Testing the initial endowment effect in experimental auctions. Appl Econ Lett. 2003;10:271–5.CrossRef
Metadata
Title
Willingness-to-pay for long-lasting insecticide-treated bed nets: a discrete choice experiment with real payment in Ghana
Authors
Y. Natalia Alfonso
Matthew Lynch
Elorm Mensah
Danielle Piccinini
David Bishai
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Malaria
Published in
Malaria Journal / Issue 1/2020
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/s12936-019-3082-6

Other articles of this Issue 1/2020

Malaria Journal 1/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine