In 2015, there were 214 million cases of malaria, and 438,000 people died from the disease, according to the World Health Organization. The majority of these deaths were in sub-Saharan Africa, which is home to an estimated 90 percent of the world’s malaria cases. Public health experts and officials have long agreed that prevention through widespread use of insecticide-treated nets (ITNs or bednets) is the most viable way to prevent and control malaria. Yet ITN coverage is woefully low among the most vulnerable groups, such as pregnant women and children.

In an IPA study, researchers found that providing people with free bednets results in near universal take-up, and 90 percent of households offered free bednets were using them for malaria protection within a year. By contrast, less than 50 percent of households have bednets to sleep under when they are required to pay, even when the fee is a fraction of the full cost.

In the past few years, many organizations have reconsidered their policies to charge for health services, opting instead to distribute ITNs and other health products free of charge. The elimination of user fees is now strongly supported by a number of influential organizations including the U.K.’s Department for International Development (DFID), Save the Children UK, the United Nations Millennium Project, and the Commission for Africa. In 2009, the British government cited the study by Cohen and Dupas, alongside Kremer and Miguel’s study on the effect of cost-sharing on deworming take-up, in calling for the abolition of user fees for health products and services in poor countries. Many countries including Burundi, Nepal, Malawi, Zambia, Sierra Leone, Ghana, and Liberia are responding to this call, taking major steps towards the provision of free services.