This study evaluates the uptake of a health-protecting technology, insecticide-treated bednets (ITNs), through micro-consumer loans, as compared to free distribution and control conditions.
Many severe health risks in developing countries could be substantially reduced with access to appropriate preventive measures. However, the associated costs are often high enough to restrict access among poor households, and free provision through public health campaigns is often not financially feasible. This study, conducted in a malaria-endemic part of Orissa, attempts to gauge the impact of two different distribution schemes: free distribution and offering nets on microcredit loans on the adoption and usage of insecticide treated nets. The study also examines the impact of ITN distribution on health outcomes.
The study was conducted in partnership with Bharat Integrated Social Welfare Agency (BISWA), a microcredit provider operating in rural Orissa. Researchers randomly selected 141 villages in a malaria-prone area of rural Orissa for participation in the study. A third of the 141 villages were randomly selected to be control villages and two-thirds of the 141 were selected for the treatment group. Researchers evenly divided the treatment group into two smaller groups: one group of villages where households received bed-nets for free and another group of villages where households received the offer to buy ITNs on contract. Researchers targeted approximately 15 randomly-selected households in each treatment and control village for the intervention.
Results from the study indicate that offering health products on microcredit may be an effective way of boosting product usage and takeup but may not be ideal for products that require high takeup in order to work. The difference between retreatment rates for the two contract types – commitment and non-commitment, suggest that organizations offering health products which require retreatment or future purchases should build in the costs of future treatments upfront to maximize effective usage. Findings also suggest that researchers should partner with other microcredit providers to explore whether offering health products on microcredit contracts can help boost their take-up, usage and effectiveness.
Results from the study suggest that public health interventions which only achieve the distribution of a relatively limited number of ITNs may fail to achieve the desired effects. Much more may be needed, and efforts should include ensuring high village-wide coverage, providing incentives for regular use, and possibly adding complementary interventions such as
indoor residual spraying, case management and environmental measures.