Willingness to pay to prevent mother to child transmission of HIV/AIDS in the Yilo and Manya Krobo Districts, Ghana

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1 Willingness to pay to prevent mother to child transmission of HIV/AIDS in the Yilo and Manya Krobo Districts, Ghana Emmanuel Ayifah 1 and Rebecca Nana Yaa Owusua 2 1 University of Ghana, ilins Project, Department of Nutrition and Food Science, Accra, Ghana. 2 International Food Policy Research Institute, Ghana Strategy Support Programme, Accra, Ghana. eayifah@yahoo.com 5/13/2011 1

2 Abstract Background: The government of Ghana in 2002 launched a comprehensive programme to prevent mother to child transmission (MTCT) of HIV/AIDS. The Prevention of Mother-to Child Transmission (PMTCT) of HIV/AIDS programme was first piloted in Atua government hospital and St Martin s de Porres Hospital, in the Yilo and Manya Krobo Districts. In Ghana PMTCT services are free. It is however worth noting that, with the ever increasing public health expenditure in recent years, the government cannot foot the bill on PMTCT all alone. There is therefore the need for individual contributions to ensure sustainability of HIV/AIDS and other health care interventions, hence the study to determine how much pregnant women will be willing-to-pay to prevent MTCT of HIV/AIDS. Materials and Methods: The study used the open ended bid elicitation method to assess pregnant women s hypothetical Willingness-to-Pay (WTP) for PMTCT of HIV/AIDS. Respondents (n=200) were drawn from two antenatal clinics (Atua Government Hospital and St. Martins Deporres Hospital) in Ghana. The Ordinary Least Squares (OLS) regression was used to evaluate the determinants of WTP. Verbal informed consent was received from participants. Results: About 84 and 94 percent of respondents from the Atua Government Hospital and St Martin s de Porres Hospital respectively were WTP for PMTCT of AIDS. WTP amount ranged between GH GH 20 ( $0.4 $14.3) with Mean WTP being GH 3.2 and GH 3.6 ($2.3 $2.6) for Atua Government Hospital and St Martin s de Porres Hospital respectively. Significant determinants of WTP for PMTCT of HIV/AIDS include Income, HIV/AIDS status and Level of education. Conclusions: Pregnant women in the Yilo and Manya Krobo Districts of Ghana would be willing to participate in cost sharing schemes that target HIV/AIDS prevention if introduced, as indicated by their WTP for PMTCT of HIV/AIDS. Income is the most significant factor influencing WTP. Keywords: willingness-to-pay; prevention of mother-to-child tansmission;hiv/aids, ghana; 5/13/2011 Ayifah E. And Owusua R. N. Y (2011) 2

3 Background Mother-to-Child Transmission (MTCT) of HIV/AIDS accounts for the highest single mode of infection in children.(unaids,1998). PMTCT services in Ghana was piloted in 2002 in two hospitals (Atua Government Hospital Yilo Krobo District and St. Martins Deporres Hospital Manya Krobo District). The number of PMTCT sites increased to 85 in 2005 and to 225 in PMTCT service is free. The true cost of service per person per year was estimated at US$ in 2003 (NACP).Government cannot meet the cost on PMTCT alone, hence the need for individuals to contribute to ensure sustainability. The study seeks to assess pregnant women s willingness-to-pay (WTP) for PMTCT of HIV/AIDS in the Yilo and Manya Krobo Districts, Ghana. WTP studies to measure the value individuals/households place on improving/preventing further deterioration in health due to HIV/AIDS (Whittington et al. 1999; Kominami et al. 2007;Muko et al. 2004;Forsythe et al. 2002). Ayifah E. And Owusua R. N. Y (2011) 5/13/2011 3

4 Ghana s HIV/AIDS Statistics ( ) Variable National 1.7% 1.9% 1.5 % Prevalence rate Site Prevalence (highest, lowest) 8.9% -Agormanya* 0.3% - Krachi 5.8% - Agormaya and Koforidua 7.8% - Agormanya 0.4% -Adibo and Prevalence among pregnant women 0.7% - North Tongu Krachi 2.2% 2.9% 2.0% New Infections 22,541 25,531 12,890 Persons with AIDS 236, ,069 (children - 25,666) 254,270 (children - 32,329) AIDS Death 18, 082 (Children-2, 2241 ) 20,313 (Children - 2,566) 16,319 (children - 1,611 ) Source: NACP, annual HIV sentinel survey reports (2008, 2009 and 2010) * Agormaya is in the study area 5/13/2011 4

5 Objectives of the Study Assess respondents knowledge about HIV/AIDS, MTCT and PMTCT of AIDS Estimate respondents WTP for PMTCT of AIDS Examine relevant determinants WTP. Provide policy recommendations. 5/13/2011 5

6 Methodology Study area Manya and Yilo Krobo Districts, Eastern Region 5/13/2011 6

7 Methodology Continued Study Population Randomly selected pregnant women attending antenatal care at Atua Government Hospital (Yilo Krobo District ) and St. Martins Deporres Hospital (Manya Krobo District ) in 2008 (February-March). Sample Size 200 pregnant women (100 per hospital) Consent - Verbal informed consent Questionnaire - knowledge about HIV/AIDS,WTP for PMTCT of HIV/AIDS &Background characteristics Method for Evaluating WTP Contingent Valuation Method (CVM) Realistic hypothetical scenario (Mitchel and Carson, 1989) PMTCT fund Minimizing budget constraint bias income and other expenses (food, clothing, and other needs) Payment Vehicle Maximum out-of-pocket monthly voluntary contribution throughout gestation period Bid Elicitation - Open ended bid elicitation format. Determinants of WTP Ordinary Least Squares (OLS) Regression 5/13/2011 7

8 Methodology Continued Hypothetical Scenario: Government is spending so much to provide the PMTCT programme. A key issue of concern however is sustainability of the various interventions. It is important for people to contribute to ensure sustainability of efforts to curb MTCT. Assuming a PMTCT fund is to be established and is to administered by the antenatal clinic. The fund would be used for purchasing antiretroviral drugs, infant formula feed, equipments for VCT, and follow up counselling. You are guaranteed that the fund will only be used for PMTCT. Minimising budget constraint bias: Before you answer this question, I would like you to reflect on your income. So after making this voluntary contribution, you must still buy food, clothing, and shelter among other things. Note that you are contributing towards preventing HIV/AIDS infection in new born babies alone but not for other health/antenatal care services. I would also like you to know that the extent to which this fund can help prevent MTCT of HIV/AIDS depends on the amount that you contribute to this fund. Open ended WTP question: Suppose you are required to contribute to the PMTCT fund, how much are you willing-to-pay per month throughout your gestation period? 5/13/2011 8

9 Definition of Variables Variable Definition Expected Sign Income monthly income + nchldn 1= At least one live child - 0 = otherwise Education 1= at least primary education + 0 = otherwise mstatus 1 = married, + 0= otherwise 0 Age age in completed years - Transport Cost pmtct HIV Status Cost of transportation to and fro the hospital 1 = knows about PMTCT 0 = otherwis 1 = Positive, 0 = otherwise /13/2011 9

10 Background Characteristics of Respondents Variable Age Education Level No education Basic (Primary/JHS) Secondary Tertiary Marital Status Not married Married Widowed Live Children No Child > =1 Child Occupation Unemployed Civil servants Petty Trading Agric related work Other Monthly Income* No income below GH 50.3 GH GH GH Aggregate sample (N=200) Yilo Krobo District Atua Government Hospital, Atua (N=100) Manya Krobo District St. Martins Depores Hospital, Agormanya (N=100) 5/13/ *Exchange rate of Gh 1.4 = $

11 HIV/AIDS Related Knowledge and WTP for PMTCT Variable Aggregate sample (N=200) Atua Government Hospital, Atua (N=100) St. Martins Depores Hospital, Agormanya (N=100) Heard about HIV/AIDS HIV/AIDS Test Yes No Results Positive Negative Knowledge of MTCT Yes No Knowledge of PMTCT Yes*** No WTP for PMTCT of HIV/AIDS Yes No** Mean WTP *Gh 3.4 ($2.4) Gh 3.2 ($ 2.3) Gh 3.6 ($ 2.6) Std. deviation WTP Range (Min, Max) GH GH 20 GH GH 20 GH GH 10 ( $0.4 $14.3) ( $0.4 $14.3) ( $0.4 $7.1) *Exchange rate of Gh 1.4 = $1 ** Unemployed = 70.4% * * * 63.4% resp. 1 st heard of PMTCT upon visiting the clinic 5/13/

12 OLS Regression Results for WTP Aggregate Sample (N=200) Atua Government Hosp. Atua (N=100) St. Martins Depores Hosp. Agormanya (N=100) Regressor Coefficients Coefficients Coefficients Income *** *** *** nchldn Education * mstatus Age Transport Cost * pmtct HIV Status ** ** *** Significant at 1% R Squared= R Squared= **Significant at 5% *Significant at 10% 5/13/ R Squared=

13 Summary of results Most respondents (N=108) were between years Awareness of PMTCT of HIV/AIDS (N=154, 77%) is relatively lower than awareness of HIV/AIDS (N=200, 100%) and MTCT of HIV/AIDS (N= 198, 99%) Average WTP = Gh 3.4 ($2.4) Income, Education and Transport cost are positively related to WTP whereas HIV/AIDS is negatively related to WTP 5/13/

14 Conclusion and Policy Recommendation Conclusions Pregnant women place high value on PMTCT of HIV/AIDS as indicated by their WTP for PMTCT. The result is consistent with theoretical construct that higher income is associated with higher WTP. Recommendations Health care financing schemes like out-of pocket payments/ user fees, Cost sharing etc. should take into consideration income levels. Intensify awareness/sensitization campaigns on PMTCT of HIV/AIDS 5/13/

15 References Forsythe, S., Arthur, G., Ngatia, G., Mutemi, R., Odhiambo, J., and Gilks, C. (2002). Assessing the cost and willingness-to-pay for voluntary HIV counselling and testing in Kenya. Oxford University Press 2002 Kominami, M., Kawata, K., Ali, M., Meena, H. and Ushijima, H. (2007). Factors determining prenatal HIV testing for prevention of mother to child transmission in Dar Es Salaam, Tanzania. Pediatrics International (2007) 49, Mitchell, R. C. and Carson, R. T. (1989). Using surveys to value public goods: the contingent valuation method. Washing, D.C., Resources for the Future Muko, K. N., Ngwa, V. C., Chingang, L.C., Meiburg, A. and Shu E. N. (2004). Willingnessto- pay for treatment of HIV with highly active antiretroviral (HAART) drugs: A rural Case Study in Cameroon. Journal des Aspects Sociaux du VIH/SIDA. Vol. 1 No. 2 AOUT 2004 National AIDS Control Programme (2003, 2008, 2009 and 20010) HIV Sentinel survey reports. Republic of Ghana UNAIDS (1998). Report on the Global AIDS Pandemic. Geneva. Switzerland Whittington, D., Matsui, O., Freiberger,J., Pattanayak, S., and Van Houtven, G.(1999). Individuals Willingness-to-pay for a HIV/AIDS Vaccine: A case study of Guadarajara, Mexico. International Conference on AIDS, 2000, Abstract no. ThOrD680 5/13/