Limited success in scaling-up ITN coverage reflects the inadequately acknowledged economic barriers that prevent the destitute sick from accessing critical preventive technologies. Despite proven efficacy and what are considered "reasonable costs," the 2003 RBM report reveals disappointing levels of ITN coverage. In 28 African countries surveyed, only (range, –) of households owned at least one ITN, and | Chapter 002. Global Issues in Medicine Part 8 Limited success in scaling-up ITN coverage reflects the inadequately acknowledged economic barriers that prevent the destitute sick from accessing critical preventive technologies. Despite proven efficacy and what are considered reasonable costs the 2003 RBM report reveals disappointing levels of ITN coverage. In 28 African countries surveyed only range of households owned at least one ITN and 2 of children slept under an ITN. Why has the RBM campaign failed to achieve its goals Do Africans not want to use bed nets Do they not recognize malaria as a health risk Or have project managers and donors miscalculated most Africans ability to obtain bed nets These are not rhetorical questions. The RBM strategy initially emphasized the importance of commercial markets as sources of ITNs for African populations. A precedent supporting this emphasis is the prior existence in countries such as Madagascar and Mali of local markets for untreated bed nets. Presumably therefore a demand for bed nets existed prior to the RBM campaign as did a distribution system with points of sale. However even with the application of subsidized social marketing strategies this market approach has not resulted in large increases in coverage during the first years of the RBM campaign. Several studies have attempted to define willingness to pay WTP and actual payment for ITNs in African countries and thereby to determine why market-based strategies have been unsuccessful. Policy-makers often use WTP figures to determine appropriate pricing for social marketing projects and to project revenue and demand. A cross-sectional study in a rural Nigerian community administered two questionnaires 1 month apart to examine community members WTP for ITNs actual purchase of ITNs with the second questionnaire accompanied by the opportunity to buy a subsidized ITN and factors such as socioeconomic status and recent history of malarial illness contributing .
