Stated Choice design comparison in a developing country: recall and attribute nonattendance

Government doctor absenteeism and its effects on consumer demand in rural north India

Government doctor absenteeism from their public posts is a sizable problem across developing economies. The consumer demand estimation for outpatient fever treatment presented in this paper investigates the interrelationship between government doctor absenteeism and the large informal healthcare sector. Using a counterfactual framework, this paper estimates treatment effect of eliminating government doctor absenteeism. The effects are measured by changes to the market share of government Bachelor of Medicine and Bachelor of Surgery (MBBS) providers and resulting own-price elasticities of demand for government MBBS providers and unqualified providers. Modelling incorporates patients expected health outcomes by provider via the use of a qualitative measure of word-of-mouth recommendations. Results indicate that eliminating government MBBS provider absenteeism in North India would increase utilisation of government outpatient fever treatments from 18% to 50%.

Information sharing and willingness-to-pay for CBPP vaccine in rural Kenya

The study estimates cattle owners' willingness-to-pay (WTP) for Contagious Bovine Pleuropneumonia (CBPP) vaccine in Samburu county, Kenya. Of particular policy relevance, the study presents findings on WTP for i) improved access to vaccines and ii) timely access to disease-risk information. The mean price for a CBPP vaccine was estimated at KES 66 (USD 0.64). This price relates to a CBPP vaccine that requires a 1.8 h commute, cattle owners' receipt of timely information that the CBPP disease risk is low-moderate and the vaccine lowers the risk of either tail-drop or post-vaccine abortion. The conditional WTP for mean travel duration and high-risk information are similar at KES 53.9 and KES 51.5. The marginal effect on demand for a 1 h additional travel duration and provision of CBPP disease risk information was estimated as a 1.5 per cent reduction and 2.3 increase. The results of this study indicate that cattle owners value greater levels of knowledge concerning the changing risk profile of CBPP in their community and improved access to CBPP vaccination services. Enhanced engagement with cattle owners concerning CBPP would likely result in a greater utilisation of available CBPP vaccines, conditional on the perceived CBPP disease risk.

Informal healthcare sector and marginalized groups: Repeat visits in rural North India

The interrelationship between the public and private sectors, and formal and informal healthcare sectors effects market-level service quality, pricing behaviour and referral networks. However, health utilisation analysis of national survey data from many low and middle income countries is constrained by the lack of disaggregated health provider data. This study is concerned with the pattern of repeat outpatient consultations for a single episode of fever from public and private qualified providers and private unqualified providers. Cross-sectional survey data from 1173 adult respondents sampled from three districts within India's most populous state-Uttar Pradesh is analysed. Data was collected during the monsoon season-September to October-in 2012. Regression analysis focuses on the pattern of repeats visits for a single episode of mild-sever fever as the dependent variable. Results show that Women and Muslims in rural north India are more likely to not access healthcare, and if they do, consult with low quality unqualified outpatient healthcare providers. For fever durations of four or more days, men are more likely to access unqualified providers compared to women. Results of the current study supports the literature that women's utilisation of outpatient healthcare for communicable illnesses in LMICs is often less than men. A relative lack of access to household resources explains why fever duration parameter estimates for women and men differ.

Using conjoint analysis to determine the impact of product and user characteristics on acceptability of rectal microbicides for HIV prevention among Peruvian men who have sex with men

OBJECTIVES

Men who have sex with men (MSM) are in need of novel and acceptable HIV prevention interventions. In Peru, a Phase II clinical trial was recently completed evaluating rectally applied tenofovir gel among Peruvian MSM and transgender women. If deemed safe and acceptable, the product could move into efficacy testing, but acceptability data for similar products are needed now in order to prepare for future implementation. Peru is in need of expanded, national acceptability data among likely users.

METHODS

Using conjoint analysis of an online cross-sectional survey taken by 1008 Peruvian MSM and transgender women, we tested the acceptability of eight hypothetical rectal microbicide (RM) products comprising six, dual-value attributes. We also assessed the relationship of select product attributes with sample characteristics.

RESULTS

Highest acceptability was found for a RM that was 90% effective, used before and after sex, without side effects, costing approximately $0.30, had no prescription requirement and had a single-use applicator. Product effectiveness and presence of side effects were the factors most likely to drive RM acceptance and use. Education, sexual orientation, sexual role and concern for HIV infection were also related to aspects of RM acceptability.

CONCLUSION

RM acceptability was high, confirming the results of earlier, smaller studies and placing confidence in the acceptability of RMs. Analysis of the relationships with product attributes and sample characteristics underscore the need to consider the impact of factors such as sexual orientation, sexual role, level of education and concern for HIV acquisition on RM acceptability.