Summary of Policy Brief
Do subsidies improve access to and use of malaria prevention treatments like Artemisinin-based combination therapies (ACTs) and insecticide-treated nets (ITNs)?
The demand for ACTs in Kenya is very low at market price. Demand increased with a very high subsidy, but nearly half of the subsidised pills went to patients without malaria. Reducing the level of subsidy greatly increases the share of subsidised pills going to malaria-positive individuals (Cohen et al., 2013).
Demand for ITNs is also sensitive to price. The uptake of ITNs among pregnant women in Kenya was significantly higher when the nets were given free than when they were charged for. And those who received free nets were no less likely to use them than those who paid for it (Cohen and Dupas, 2010). Distribution of free mosquito nets in Uganda also led to a greater number of children covered than when the nets were sold (Hoffmann, 2009).
That people won't pay may reflect poverty and not necessarily indicate that they do not value the nets. The purchase of ITNs in Orissa, India shot up dramatically when credit was offered for the purchase compared to when the nets had to be paid for in full and in cash (Mahajan et al.,2009).
The results of these studies indicate the trade-off to be made between access and affordability of malaria-prevention treatment. In the case of ACTs, there is the additional consideration of efficient targeting, not only because of the inefficiency of treating those who don't need it, but also because over-treatment of those not afflicted with malaria can contribute to parasite resistance to anti-malarials.