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Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya.

ABSTRACT: Poor sanitation worldwide leads to an annual loss of approximately $222.9 billion and is the second leading cause of Disability-Adjusted Life Years (DALY's) lost due to diarrhoea. Yet in Kenya, the slow rate and levels at which the household's access improved sanitation facilities remain a concern, and it is unknown if the cost of new technologies is a barrier to access. This study assessed the maximum willingness to pay (WTP) for SAFI and SATO sanitation products and identified those factors that affect the willingness to pay (WTP) valuation estimates by households in three counties in Kenya. It used quantitative economic evaluation research integrated within a cross-sectional survey. Contingent valuation method (CVM) was used to determine the maximum WTP for sanitation in households. We used the logistic regression model in data analysis. A total of 211 households were interviewed in each county, giving a total sample size of 633 households. The mean WTP for SAFI latrines was $153.39 per household, while the mean WTP for SATO pans and SATO stools was $11.49 and $14.77 respectively. For SAFI latrines, households in Kakamega were willing to pay $6.6 more than average while in Siaya, the households were willing to pay $5.1 less than the average. The main determinants of households WTP for the two sanitation products included household's proximity to the toilet (p = 0.0001), household income (β = .2245741, p = 0.004), sanitation product (β = -2968.091; p = 0.004), socioeconomic status (β = -3305.728, p = 0.004) and a household's satisfaction level with the current toilet (β = -4570.602; p = 0.0001). Increased proximity of households to the toilet, higher incomes, and providing loan facilities or subsidy to poor households could increase the demand for these sanitation technologies.

SUBMITTER: Mulatya DM

PROVIDER: S-EPMC8092787 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundIn Kenya, health service delivery and access to health care remains a challenge for vulnerable populations, particularly pregnant women and children below five years. The aim of this study, therefore, was to determine the positivity rate of Plasmodium falciparum parasites in pregnant women and children below five years of age seeking healthcare services at the rural health facilities of Kwale and Siaya counties as well as their access and uptake of malaria control integrated services, like antenatal care (ANC), offered in those facilities.MethodsCluster random sampling method was used to select pregnant women and children below five years receiving maternal and child health services using two cross-sectional surveys conducted in eleven rural health facilities in two malaria endemic counties in western and coastal regions of Kenya. Each consenting participant provided single blood sample for determining malaria parasitaemia using microscopy and polymerase chain reaction (PCR) techniques.ResultsUsing PCR technique, the overall malaria positivity rate was 27.9% (95%CI: 20.9-37.2), and was 34.1% (95%CI: 27.1-42.9) and 22.0% (95%CI: 13.3-36.3) in children below five years and pregnant women respectively. Additionally, using microscopy, the overall positivity rate was 39.0% (95%CI: 29.5-51.6), and was 50.4% (95%CI: 39.4-64.5) and 30.6% (95%CI: 22.4-41.7) in children below five years and pregnant women respectively. Siaya County in western Kenya showed higher malaria positivity rates for both children (36.4% and 54.9%) and pregnant women (27.8% and 38.5%) using both PCR and microscopy diagnosis techniques respectively, compared to Kwale County that showed positivity rates of 27.2% and 37.9% for children and 5.2% and 8.6% for pregnant women similarly using both PCR and microscopy techniques respectively. Pregnant women presenting themselves for their first ANC visit were up to five times at risk of malaria infection, (adjusted odds ratio = 5.40, 95%CI: 0.96-30.50, p = 0.046).ConclusionDespite evidence of ANC attendance and administration of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) dosage during these visits, malaria positivity rate was still high among pregnant women and children below five years in these two rural counties. These findings are important to the Kenyan National Malaria Control Programme and will help contribute to improvement of policies on integration of malaria control approaches in rural health facilities.

Project description:BackgroundThis study explores the consequences of a maternal death to households in rural Western Kenya focusing particularly on the immediate financial and economic impacts.MethodsBetween September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy and health care access and utilization; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions.ResultsThe health service utilization costs associated with maternal deaths were significantly higher, due to more frequent service utilization as well as due to the higher cost of each visit suggesting more involved treatments and interventions were sought with these women. The already high costs incurred by cases during pregnancy were further increased during delivery and postpartum mainly a result of higher facility-based fees and expenses. Households who experienced a maternal death spent about one-third of their annual per capita consumption expenditure on healthcare access and use as opposed to at most 12% among households who had a health pregnancy and delivery. Funeral costs were often higher than the healthcare costs and altogether forced households to dis-save, liquidate assets and borrow money. What is more, the surviving members of the households had significant redistribution of labor and responsibilities to make up for the lost contributions of the deceased women.ConclusionKenya is in the process of instituting free maternity services in all public facilities. Effectively implemented, this policy can lift a major economic burden experienced by a very large number of household who seek maternal health services which can be catastrophic in complicated cases that result in maternal death. There needs to be further emphasis on insurance schemes that can support households through catastrophic health spending.

Project description:BackgroundThis study examined the acceptance and willingness to pay (WTP) of rural residents toward packaging cancer screening (PCS) to provide a reference basis for promoting the screening sustainable development.MethodsA face-to-face questionnaire survey was conducted among rural residents aged 40-69. The combination of double-bounded dichotomous choices and open-ended questions in the Contingent Valuation Method was used to guide participants' WTP. Logistic regression was used to explore the influencing factors of participants' screening acceptance, and Tobit model was used to analyze the associated factors of WTP.ResultsOf the 959 respondents, 89.36% were willing to accept PCS, but 10.64% stated unwillingness for the dominant reason that they did not attend clinics until symptom onset. Willingness to accept screening was significantly associated with region (Dongchangfu, OR = 0.251, 95%CI: 0.113~0.557; Linqu, OR = 0.150, 95%CI: 0.069~0.325), age with 60-69 (OR = 0.321, 95%CI: 0.126~0.816), annual income with 10,000-30,000 (OR = 1.632, 95%CI: 1.003~2.656) and having cancer-screening experience (OR = 0.581, 95%CI: 0.371~0.909). And 57.66% of participants were willing to pay part of the screening cost among those willing to accept PCS. The residents' average WTP was ¥622, accounting for 20.73% of the total cost (¥3000). Willingness to pay for PCS was positively correlated with male gender, self-employed occupation, residence in Feicheng (than Linqu), higher income, and having cancer-screening experience.ConclusionsMost rural residents were willing to accept free PCS, more than half of them were willing to pay part of the ¥3000 total cost, but their WTP-values were low. It is necessary to carry out PCS publicity activities to improve public awareness and participation in precancerous screening. Additionally, for expanding the coverage and sustainability of screening, the appropriate proportion of rural residents to pay for screening costs should be controlled at about 20%, and governments, insurance and other sources are encouraged to actively participate to cover the remaining costs.

Project description:Edible insects are increasingly being considered as sustainable alternatives to fish and soybean meals in animal feed because of their high nutritional quality and environmental benefits. However, successful introduction of a new product to the market depends on the target user's acceptance. Thus, evaluating the potential demand of insect-based feeds would provide relevant information for policy development. The present study assessed farmers' knowledge on edible insects as feed, their acceptance of integrating insect meals in animal feeds and willingness to pay (WTP) for insect-based feed (IBF) using a contingent valuation method. A household survey was conducted among 957 randomly selected farmers including: 409 poultry, 241 fish and 307 pig farmers in four counties in Kenya. Results of the study reveal that over 70 and 80% of poultry and fish farmers, respectively, are aware that insects can be used as a feed ingredient. In addition, over 60 and 75% of poultry and fish farmers, respectively, consider insects as a good component of feed. Poultry, pig and fish farmers interviewed accepted and showed willingness to pay for IBF. Regression analysis indicated that age, gender, education, marital status, distance to feed trader, awareness of insects as feed, attitude towards insects, acceptance of insect species, availability of agricultural inputs, use of commercial feeds, availability of training and market information had a significant influence on the WTP for IBF. Therefore, increased extension services to educate famers on the nutritional benefits of insect meals in animal feeds and existing market opportunities are expected to improve farmers' attitude towards utilization and consequently enhance WTP for IBF, which in return would significantly reduce the existing pressure on conventional fishmeal feed resources. Our findings provide the first insights into the market opportunities of including insect meals in the animal feed value chain in Kenya.

Project description:Background: Health insurance is seen as a pathway to achieving Universal health coverage in low- and middle-income countries. The Nigeria Government has mandated states to set up social health insurance as a mechanism to offer financial protection to her citizens. However, the design of these schemes has been left to individual states. In preparation for the set-up of a contributory social health insurance scheme in Akwa Ibom State, Nigeria. This study assesses the willingness-to-pay for a social health insurance among rural residents in the state. Methods: The study was conducted in three local government areas in Akwa Ibom State, South south Nigeria. It was a cross-sectional study with multi-stage data collection using a demand questionnaire. Interviews were conducted with 286 household heads who were bread winners. Contingent valuation using iterative bidding with double bounded dichotomous technique was used to elicit the WTP for health insurance. Multiple regression using least square method was used to create a model for predicting WTP. Findings: About 82% of the household heads were willing to pay insurance premiums for their households. The median WTP for insurance premium was 11,142 Naira ($29), 95% CI: 9,599-12,684 Naira ($25-$33) per annum. The respondents were predominantly middle-aged (46.8%), Ibibio men (71.7%) with an average household size of five persons and bread winners who had secondary education (43.0%) and were mainly pentecostals (51.5%). The mean age of respondents was 46.4 ± 14.5 yrs. The two significant predictors of WTP for insurance premium amongst these rural residents were income of breadwinner (accounts for 79%) and size of household (2%). The regression coefficients for predicting WTP for insurance premium are intercept of 2,419, a slope of 0.1763 for Bread winner income and a slope of 741.5 household size, all values in Naira and kobo. Conclusion: Majority of rural residents in Akwa Ibom State were willing to pay for social health insurance. The amount they were willing to pay was significantly determined by the income of the breadwinner of the household and the size of the family. These findings are relevant to designing a contributory social health insurance scheme that is affordable and sustainable in order to ensure universal health coverage for the citizens.

Project description:DTaP-HBV-IPV-Hib hexavalent vaccine has been used in high-income countries for many years to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive Haemophilus influenzae type b disease. Currently, no hexavalent vaccines have been approved for use in China. Evidence of parental acceptance and interest in hexavalent vaccines can help policy makers and manufacturers make decisions about entering the vaccine market and the immunization program in China. We measured parental acceptance and willingness-to-pay (WTP) for a hexavalent vaccine to provide such evidence. We conducted a cross-sectional survey of children's caregivers in 16 vaccination clinics in seven cities in China and obtained information on socio-demographics, knowledge of disease, confidence in vaccines, previous vaccination experience, and acceptance of and WTP for hexavalent vaccine. Multivariate logistic regression was used to determine factors influencing acceptance, and multivariate tobit regression was used to identify factors impacting WTP. Between April 28 and June 30, 2023, a total of 581 parents of children aged 0-6 years participated in the survey; 435 (74.87%, 95% CI:71.3%-78.4%) parents indicated acceptance of hexavalent vaccine. Residence location, parents' education level, experience paying for vaccination, and disease knowledge scores were key factors affecting parents' choices for vaccination. Mean (SD) and median (IQR) willingness to pay for full 4-dose course vaccination were 2266.66 (1177.1) CNY and 2400 (1600-2800) CNY. Children's age (p < .001), parents' education level (p = .024), and perceived price barriers (p < .001) were significantly associated with WTP. Parents have high acceptance and willingness to pay for hexavalent vaccine. The less money parents have to pay out of pocket, the more willing they can be to accept the vaccine. Therefore, acceptance may increase even further if the vaccine is covered by medical insurance, provided free of charge by the government, or if its price is reduced. Our results provide reference for optimizing and adjusting immunization strategies in China.

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Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya.

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