QUESTION:

Why do people have to pay for the bed nets?  I think that is mean to the people and they should get them for free.

ANSWER:

You have hit on a very important and on-going debate in the malaria control community. In many places around the world, organisations such as UNICEF have distributed free, insecticide-treated bednets, and especially to mothers—pregnant women and children under five are the groups most at risk from dying from malaria.

In 2010, UNICEF reported that together with its partners (WHO, the EU and the World Bank, to name a few) 5.5 million free bednets have been distributed in DR Congo alone. Similarly, in Mozambique, the Malaria Consortium has been working in a partnership with DFID and the public sector to distribute 400,000 bednets to pregnant women as part of an ante-natal service, again targeting some of the most at-risk people.

However, you are right to say that in some cases, people have to pay for bednets; in some of the poorest countries in the world, this can seem like an unjustifiable expense. However, there are some arguments in favor of having people buy their bednets.

For example, some people argue that a purely public donation initiative is unsustainable, and in order to have an on-going distribution campaign, the private sector has to be involved at some level, and this usually means charging a fee for each bednet. Moreover, forcing people to buy their own nets would free up donor funds for other purposes. Similarly, it is thought in some circles that having payment encourages suppliers to continue producing and selling nets. Finally, there are suggestions that purchasing a bednet increases their value to the recipient, who subsequently uses their net more frequently and more reliably in the manner in which it is intended (and not, for example, as a spare fishing net, as I’ve seen in parts of Uganda!).

I believe a study in Malawi showed that by asking people in urban areas, who have a bit more disposable income, to purchase full-price bednets, the program was able to generate sufficient funds to offer bednets at a highly subsidized cost in rural, poorer areas of the country; by asking people to purchase the nets, the program believed bednet usage among its recipients was higher overall, than if the nets had been given out for free.

I think the organization that tried this approach was called PSI (Population Services International)—they also offered nurses a small monetary incentive to sell bed nets (at the small sum of 50 cents each) to the rural women who attended pre-natal clinics, thus encouraging them to offer the nets widely to pregnant women.

As the final word, a study in Kenya recently showed that as costs for services such as bednets increased, demand for the service among the poorest sectors of the population declined sharply. Instead, it seemed most economical and efficient to target high-risk groups with free bednets, who are also incentivized to use the product properly and value the protection it confers, such as pregnant women in ante-natal settings, rather than doling them out to the community at large.

So we’re back to where I started with this response; the great job that many organizations out there are doing in distribution insecticide-treated bednets to the people who need it the most, and who can’t afford to buy them themselves, although it is worth bearing in mind that alternative models of bednet funding and distribution might prove equally beneficial and potentially more sustainable, at least in certain areas.

I’m also going to ask Hugo Gouvras to weigh in on this one—he works for Malaria No More, an organization that has recently launched an innovative mechanism for accelerating funding provision for bednet distribution to Africa. Hopefully he can update anything that I have said which is old news, and provide additional information!