Abstract
Disease burden of malaria in Papua New Guinea (PNG) is the highest in Asia and the Pacific, and prompt access to effective drugs is the key strategy for controlling malaria. Despite the rapid economic growth, primary healthcare services have deteriorated in rural areas; the introduction of non-professional health workers [village health volunteers (VHVs)] is expected to improve antimalarial drug deliveries. Previous studies on PNG suggested that distance from households negatively affected the utilization of health services; however, price effect on healthcare demand decisions has not been explored. Empirical studies on household's affordability as well as accessibility of healthcare services contribute to policy implications, such as efficient introduction of out-of-pocket costs and effective allocation of health facilities. Therefore, we investigate price responsiveness and other determinants of healthcare provider choice for febrile children in a malaria endemic rural area wherein VHVs were introduced. Cross-sectional surveys were conducted using a structured questionnaire distributed in a health center's catchment area of East Sepik Province in the 2011/2012 rainy seasons. Caretakers were interviewed and data on fever episodes of their children in the preceding 2 weeks were collected. Mixed logit model was employed to estimate the determinants of healthcare provider choice. Among 257 fever episodes reported, the main choices of healthcare providers were limited to self-care, VHV, and a health center. Direct cost and walking distance negatively affected the choice of a VHV and the health center. An increase of VHV's direct cost or walking distance did not much affect predicted probability of the health center, but rather that of self-care, while drug availability and illness severity increased the choice probability of a VHV and the health center. The results suggest that the net healthcare demand increases with the introduction of a VHV. Allocations from the government's budget are required to sustain VHV activities because the introduction of a small user fee could impede the utilization of a VHV. A large travel cost related to the choice of the health center suggests that resource allocation is required for the expansion of formal healthcare providers to adequately operate a referral system.
Highlights
In Papua New Guinea (PNG), malaria is the leading cause of outpatient visits, the second leading cause of hospital admissions, and the fourth leading cause of hospital deaths [1]
Despite the rapid economic growth, primary healthcare services have deteriorated in rural areas; the introduction of non-professional health workers [village health volunteers (VHVs)] is expected to improve antimalarial drug deliveries
This study had the following four main findings related to choosing healthcare providers for febrile children. (a) Direct cost was a negative significant determinant of the choice of both a VHV and the health center, (b) the choice probability of both a VHV and the health center significantly declined as the walking distance from them increased, (c) drug availability significantly increased the probability of VHV utilization, and (d) illness severity was another significant determinant of the choice of both a VHV and the health center
Summary
In Papua New Guinea (PNG), malaria is the leading cause of outpatient visits, the second leading cause of hospital admissions, and the fourth leading cause of hospital deaths [1]. The disease burden of malaria in PNG, which is the highest in Asia and the Pacific, was estimated to be 17.6 disability-adjusted life years per 1,000 capita per year in 2010.1 Along with improvements in vector control using a long-lasting insecticidal net, maximizing access to prompt quality diagnoses and appropriate treatment for malaria are key to reducing malaria-related morbidity and mortality, as proclaimed by the PNG National Health Plan 2011–2020 [2]. Improving service delivery in rural regions wherein the majority (89%) of the population lives is the top health priority for achieving the key strategy for malaria control [2]. Disease burden of malaria in Papua New Guinea (PNG) is the highest in Asia and the Pacific, and prompt access to effective drugs is the key strategy for controlling malaria. Despite the rapid economic growth, primary healthcare services have deteriorated in rural areas; the introduction of non-professional health workers [village health volunteers (VHVs)] is expected to improve antimalarial drug deliveries. We investigate price responsiveness and other determinants of healthcare provider choice for febrile children in a malaria endemic rural area wherein VHVs were introduced
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