Commitment Mechanisms and Compliance with Health-Protecting Behavior: Preliminary Evidence from Orissa, India.

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 malaria-related 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 * We are deeply indebted to BISWA and especially to Khirod Chandra Malick, Dipti Pattnaik and Asish Sahoo for invaluable help in designing the micro-loan products and above all for facilitating access to villages covered by their microfinance network, to for their superb work in supervising the project and to the whole team of survey monitors in Sambalpur for their tireless effort. We are also very grateful to Annie Duflo and the Center for Micro Finance for invaluable help in making this study possible. We would also like to thank Ravi and Saurabh Singhal of Biotech International for their generous donation of ITNs for the study. Committee on Faculty Research. We are also grateful to seminar participants at Wisconsin for useful comments and conversations. We are solely responsible for all errors and omissions. 1 Several public health programs are currently expanding the use of bednets with long-lasting insecticide woven into the fabric which do not require such periodic retreatment.