Factors Affecting Women-Willingness to Pay for Maternal, Neonatal andChild Health Services (MNCH) in Gombe State, Nigeria

Abstract

Background: Gombe State in North Eastern Nigeria is one of the states in the region that records the highest maternal and new-born death rates in the world. The region has a maternal mortality ratio of 1549/100,000, child mortality rate of 260/1,000 and neonatal mortality rate of 43/1,000. With a poverty incidence of 72.2% in the state and the displacement due to insurgency, a great deal of women in the villages is vulnerable to more poverty and maternal deaths. Establishing the factors that affect the willingness to pay (WTP) for maternal services will help to improve maternal health services thereby reducing maternal deaths in the state. This study looked at the factors that affect women’s willingness to pay for maternal services in relation to antenatal care (ANC), delivery in health facilities and post-natal care (PNC) through a baseline survey. Methods: This study was cross sectional where data were collected from women groups (including women not registered with the groups) in two purposively selected Local Government Areas (LGAs) of the state. Seven hundred and fifty (750) women were sampled for the survey in the two LGAs. The main outcome variables are utilization of maternal service (specifically improved antenatal care attendance, facility delivery and postnatal care) and WTP for these services by the women. Descriptive statistics of the respondents were analysed using IBM SPSS 22 software. Logistic regression analysis was done to determine the factors affecting WTP for the maternal services. Results: The findings from this study have shown statistically significant association between WTP for maternal health care and several factors. Women are more likely to be willingness to pay for ANC and delivery in the health facility if they belong to the savings and loans group (p<0.05), had an average of 1-10 visits to a facility, married (p<0.05), can read and write in English (p<0.05) and live near health facilities (p<0.05). Income and employment (p<0.05) are additional factors affecting WTP for delivery. Post-natal care on the other hand was only associated with membership of savings and loans group. Conclusions: Factors associated with the willingness to pay ANC and delivery in health facilities according to the findings of this study were membership of savings and loans group, closeness to a health facility, education, income and marital status. Number of previous visits to the health facility and occupation were also found to be significant predictors of willingness to pay for maternal services. Further studies on the association of WTP and PNC are suggested in order to improve PNC in the state.