Chapter 15: The Demand for Insecticide-Treated Mosquito Nets: Evidence from Africa
Christine Poulos, Maureen Cropper, Julian Lampietti, Dale Whittington and Mitiku Haile 15.1 Introduction Brouwer and Koopmanschap (2000) discuss the diﬀerences between what they call the ‘welfarist’ and ‘extra-welfarist’ perspectives on economic evaluations of health interventions. The ‘welfarist approach’, characterized by Harrington and Portney (1987) and Berger et al. (1994), aims to embed evaluations in welfare economics. The ‘extra-welfarist’ approach, characterized by Cuyler (1991) and Williams (1993), aims to help decision makers maximize health from a given budget by ‘replacing utility with health as the outcome of interest for evaluation’ (Brouwer and Koopmanschap, 2000: 444). While Brouwer and Koopmanschap take aim at the controversial assumptions underlying welfarist evaluations, this study shows that welfarist approaches convey information about individual behavior, which has implications for both health outcomes and health budgets. This study bridges the gap between welfarist and extra-welfarist perspectives by estimating a household demand for insecticide-treated bednets (ITNs) that allows policy makers to balance the goal of cost recovery against the desire to guarantee that a certain fraction of the population receives protection from malaria and other vector-borne diseases. ITNs have helped to reduce the incidence of malaria and other vector-borne illness in various parts of Africa (Binka et al., 1997), but their use as a health intervention raises an important policy question: should ITNs be provided privately or publicly? If they were sold privately, how many bednets would be purchased (at various prices)? This information would help public health agents balance the goals of cost recovery – which is necessary...
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