Willingness to Pay for Improved Quality of Services from Informal Health Providers in Urban Slums in Nigeria.

Abstract

Introduction: The shortage of formal healthcare providers in urban slums has resulted in the widespread presence of untrained informal healthcare providers (IHPs), who often deliver low-quality services. Integrating these IHPs into the formal healthcare system through capacity-building initiatives could enhance the quality of services offered to clients. However, this may lead to an increase in healthcare costs, which would be passed on to the clients. This paper provides new evidence on the level of households' willingness to pay (WTP) for improved quality of services from IHPs that will be occasioned by linking IHPs to the formal health system.

Methods: The levels of consumers' WTP for linking IHPs to the formal health system for improved quality of services was elicited using the contingent valuation method (CVM) in eight slums from two states in southeast Nigeria, namely Anambra and Enugu. A pre-tested interviewer-administered questionnaire was used to elicit WTP from 1025 randomly selected households from the slums. Data were analyzed using R and Stata software. Univariate, bivariate, and multivariate analyses were performed. Theoretical validity of WTP was analyzed using both multiple logistic and Tobit regression analyses at 95% confidence level.

Findings: Findings showed that 64.5% of households were willing to make a one-off payment for linkages that will ensure improved quality of services from IHPs. The mean willingness-to-pay amount was Nigerian naira (₦)1353 (US $2.08), and 27.1% of the households were willing to pay ≥ ₦1353 ($2.08). Higher asset index and socioeconomic status were positively associated with willingness to pay for improved quality of health services. Each unit increase in asset index was associated with a 28% increase in the odds of willingness to pay (odds ratio (OR) 1.28; p < 0.001), while each unit increase in socioeconomic status score was associated with an 86% increase in the odds of willingness to pay (OR 1.86; p < 0.001). Compared with households that usually seek care from formal providers, those that usually seek care from informal providers (OR 0.4; p = 0.01) and those that usually seek care from both provider types (OR 0.34; p = 0.01) were significantly less likely to express willingness to pay for improved quality of health services.

Conclusions: The level of WTP for linking IHPs with the formal health system is an indication that a considerable proportion of urban slum dwellers desire to have better quality of services and are willing to support interventions that can be used to actualize the linkages. Hence, such interventions would be acceptable to slum dwellers.