Household demand for insecticide-treated bednets in Tanzania and policy options for increasing uptake.

There has been considerable controversy about the most appropriate means of delivering insecticide-treated nets (ITNs) to prevent malaria. Household demand for ITNs is a key factor influencing the choice of delivery strategy, but evidence to date about price and income elasticities comes either from studies of hypothetical willingness to pay or small-scale policy experiments. This study estimates the price and income elasticities of demand for ITNs using nationally representative household survey data and actual consumer choices, in the context of a national scheme to provide vouchers for subsidized nets to pregnant women in Tanzania. Under this distribution system, the estimated price elasticity of demand for subsidized ITNs equals -0.12 and the income elasticity estimates range from zero to 0.47, depending on household socio-economic status. The model also shows a substantial decline in short-term ITN purchases for women whose household received a free ITN. These findings suggest that if the Tanzanian government continues to use a mixed public-private model to distribute ITNs, increasing the consumer subsidy alone will not dramatically improve ITN coverage. A concerted effort is required including an increase in the subsidy amount, attention to income growth for poor households, increases in women's and girls' education levels, and expansion of the retail ITN distribution network. Use of a catch-up campaign to distribute free ITNs would increase coverage but raises questions about the effect of households' long-term purchase decisions for ITNs.