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Commitment Mechanisms and Compliance with Health-protecting Behavior: Preliminary Evidence from Orissa (India)

Aug 2009
Working Paper
08-043
By  Brian Blackburn, Aprajit Mahajan, Alessandro Tarozzi, Joanne Yoong

Transmitted by Anopheles mosquitoes, malaria has one of the heaviest global health burdens, with a global incidence of 300-660 million cases every year, of which 80 million cases are in India alone (Robert W. Snow et al. 2005, Eline Korenromp 2005). According to recent estimates, one third of the human population lives in areas exposed to the most severe form of malaria, caused by Plasmodium falciparum (Snow et al. 2005). Malaria infection may develop into severe febrile episodes and lead to chronic effects and possibly death, and is particularly dire among young children and pregnant women (Joel G. Breman 2001). Numerous studies have shown that insecticide-treated bednets (ITNs) are one of the most effective means of reducing malariarelated morbidity and mortality (C Lengeler 2004). However, ITN adoption in most malarious areas remains very low and public health interventions frequently have insufficient resources to provide complete ITN coverage for all individuals at risk. Although treatment of nets with insecticide is relatively safe, efficacious and inexpensive, regular retreatment is rare even among bednet users.1 Cost is often cited as the most obvious explanation for low usage and retreatment rates, but other likely factors are lack of proper information about potential benefits and inability to set aside the relatively small amounts of money that are necessary for the purchase and maintenance of nets. The difficulty of inducing sustained compliance with health-protecting behavior is a common obstacle in public health initiatives (Michael Kremer and Edward Miguel 2007). Researchers have argued that commitment devices can help poor households to overcome time-inconsistency in their preferences (Nava Ashraf, Dean Karlan and Wesley Yin 2006, Esther Duflo, Michael Kremer and Jonathan Robinson 2006).