Kenya Insecticide-Treated Bednet Distribution

Summary

This study addressed a fundamental debate in development economics: does charging even a small price for a health product increase recipients' commitment to using it (the 'sunk cost' hypothesis)? The answer for bednets was no. Free recipients used their nets at the same rate as those who paid. Price was purely a take-up barrier, not a commitment device. The finding helped shift global malaria prevention policy toward free mass distribution of long-lasting insecticide-treated nets, a policy credited with saving millions of lives. Pascaline Dupas and others replicated the finding across multiple health products.

Research question

"Does subsidizing or freely distributing insecticide-treated bednets (ITNs) increase usage compared to charging market prices?"

Methodology

Result

Positive

Free distribution: 99% take-up; subsidized (10 cents): 75%; near-market price: 25%; usage among recipients did not differ significantly by price paid; no 'free makes you value it less' effect found

Evidence strength

Strong

Randomized trial, replicated across multiple sites or studies.

Replication status

Replicated