To buy or not to buy? Communities and bed nets in rural Ghana

In some parts of Ghana, untreated bed nets to prevent mosquito bites are commonly used. Why do some Ghanaians choose these over more effective insecticide treated nets?

Although studies in Ghana have shown that insecticidetreated nets (ITNs) are effective, this has not yet translatedinto an increased supply and use of ITNs across thecountry. A study in two rural communities, Obosomase (inthe forest zone) and Galo-Sota (in the coastal savannahzone), looked at the factors which influence people's decisions to buy and usebed nets. Findings include:

• In Galo-Sota 98 percent of people, compared to only fourpercent in Obosomase, slept under untreated bed nets.
• Lessthan three percent of people in both communities used ITNs.
• Allbut one respondent in Galo-Sota had heard about ITNs on the radio or from clinic staff, and all exceptone person in Obosomase said they would like toown and sleep under an ITN if they could afford one.
• Onaverage, residents of Obosomase were willing topay Ghanaian Cedi 25,000 (US$2.75) for a family-sized ITN, while those in Galo-Sota were willing to pay Cedi 40,000 (US$4.37).
• Currently,a medium-sized ITN is sold for between Cedi 70,000 (US$7.64) and Cedi 80,000(US$8.73) in large town markets. However, they are not available to peopleliving in small rural towns and villages. 
• Thesize of ITNs being sold to pregnant women atselected clinics at a subsidised price of Cedi 20,000 was considered toosmall as children often sleep in the same bed as their parents.

Whilst insecticides to treat bed nets are available in largetowns and cities, they are not available in smaller towns and villagers wherethey are most needed. No shops in the study areas sold insecticide.

These findings show that residents in these two communities,but more especially those in Galo-Sota, recognise thevalue of ITNs and are willing to own and use them.However, they continue to face the challenge of where to find the right sized ITNs at prices they can afford. Findings from the studysuggest that:

• there is a need to bridge stated willingness to pay andprice through identifying further sources of subsidy for ITNs. The Global Fund offers one possible source. Itis important that the subsidy is channelled so as not to undermineexisting distribution channels, for example through urban shops
• use of ITNs might beincreased if they were more accessible for purchase in small rural townsand villages. Strategies involving public and private distributionoutlets, such as schools, clinics and small shops should be developed
• local manufacture of ITNsshould be encouraged and supported by the government to adapt productionto meet the social and cultural needs of local people in terms of the size,shape and colour of ITNs.

The low use of ITNs in Ghana cannotbe blamed on whether or not a community accepts their usefulness. Availability,affordability and the match between products offered and cultural factors likelocal sleeping arrangements influence households' purchasing of ITNs.