Coping Costs Research Articles

The costs of delay in infrastructure investments: A comparison of 2001 and 2014 household water supply coping costs in the Kathmandu Valley, Nepal

AbstractIn 2001, we conducted a survey of 1500 randomly sampled households in Kathmandu to determine the costs people were incurring to cope with Kathmandu's poor quality, unreliable piped water supply system. From 2001 until 2014, there was little additional public investment in the municipal water supply system. In the summer of 2014, we attempted to reinterview all 1500 households in our 2001 sample to determine how they had managed to deal with the growing water shortage and the deteriorating condition of the piped water infrastructure in Kathmandu and to compare their coping costs in 2014 with those we first estimated in 2001. Average household coping costs more than doubled in real terms over the period from 2001 to 2014, from US$5 to US$12 per month (measured in 2014 prices). The composition of household coping costs changed from 2001 to 2014, as households responded to the deteriorating condition of the piped water infrastructure by drilling more private wells, purchasing water from both tanker truck and bottled water vendors, and installing more storage tanks. These investments and expenditures resulted in a decline in the time households spend collecting water from outside the home. Our analysis suggests that the significant increase in coping costs between 2001 and 2014 may provide an opportunity for the municipal water utility to substantially increase water tariffs if the quantity and quality of piped services can be improved. However, the capital investments made by some households in private wells, pumping and treatment systems, and storage tanks in response to the delay in infrastructure investment may lock them into current patterns of water use, at least in the short run, and thus make it difficult to predict how they would respond to tariff increases for improved piped water services.

How Do Households Respond to Unreliable Water Supplies? A Systematic Review.

Although the Millennium Development Goal (MDG) target for drinking water was met, in many developing countries water supplies are unreliable. This paper reviews how households in developing countries cope with unreliable water supplies, including coping costs, the distribution of coping costs across socio-economic groups, and effectiveness of coping strategies in meeting household water needs. Structured searches were conducted in peer-reviewed and grey literature in electronic databases and search engines, and 28 studies were selected for review, out of 1643 potentially relevant references. Studies were included if they reported on strategies to cope with unreliable household water supplies and were based on empirical research in developing countries. Common coping strategies include drilling wells, storing water, and collecting water from alternative sources. The choice of coping strategies is influenced by income, level of education, land tenure and extent of unreliability. The findings of this review highlight that low-income households bear a disproportionate coping burden, as they often engage in coping strategies such as collecting water from alternative sources, which is labour and time-intensive, and yields smaller quantities of water. Such alternative sources may be of lower water quality, and pose health risks. In the absence of dramatic improvements in the reliability of water supplies, a point of critical avenue of enquiry should be what coping strategies are effective and can be readily adopted by low income households.

Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis

BackgroundWhile investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients.MethodsA cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients’ Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables.ResultsOf the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient’s household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684).ConclusionDespite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0187-9) contains supplementary material, which is available to authorized users.

Network Trade and Development: What Do Patterns of Vertically Specialized Trade in ASEAN Tell Us About India’s Place in Asian Production Networks?

At a time when regional production networks have been resurgent, especially in Asia, why has India’s integration in regional markets not been deeper? Using highly disaggregated trade data and firm level field interviews, the paper found that despite low volumes, vertically specialized trade has been growing between India and ASEAN. Overall, we find that there is significant potential for deepening India’s engagement in ASEAN by expanding intermediates exports in the machinery sector, expanding into higher value specialty chemicals exports, unlocking the underexploited potential for growth in the electronics sector and moving up the value chain in the road vehicles and, telecommunications sectors where network exports are already important. Our field level interviews bear out these findings and show that besides the usual policy costs associated with supply side constraints in Indian manufacturing three factors hamper India’s deeper integration in Asian production networks: (i) low value addition in Indian manufacturing which translates into low-value component exports and a high degree of reliance on expensive imports creating a perverse effect on both learning and trade balance; (ii) a janus faced effect on technological change and productivity stemming from relatively low quality standards associated with cost-sensitive demand from domestic buyers and weak exports. This leads to technological stagnation on the one hand, and a growing capital intensity of routine operations on the other. (iii) and finally, despite the rise of export oriented industrial parks and SEZ’s there is a striking lack of an effective institutional eco-system of industrial advantage that agglomeration economies and colocation of interdependent, sectorally specialized firms can bring. Instead, sectoral fragmentation adds to manufacturing costs despite co-location. Although some firms have found innovative ways to cope, the coping costs are high.

The costs of coping with poor water supply in rural Kenya

AbstractAs the disease burden of poor access to water and sanitation declines around the world, the nonhealth benefits––mainly the time burden of water collection – will likely grow in importance in sector funding decisions and investment analyses. We measure the coping costs incurred by households in one area of rural Kenya. Sixty percent of the 387 households interviewed were collecting water outside the home, and household members were spending an average of 2–3 h doing so per day. We value these time costs using an individual‐level value of travel time estimate based on a stated preference experiment. We compare these results to estimates obtained assuming that the value of time saved is a fraction of unskilled wage rates. Coping cost estimates also include capital costs for storage and rainwater collection, money paid either to water vendors or at sources that charge volumetrically, costs of treating diarrhea cases, and expenditures on drinking water treatment (primarily boiling in our site). Median total coping costs per month are approximately US$20 per month, higher than average household water bills in many utilities in the United States, or 12% of reported monthly cash income. We estimate that coping costs are greater than 10% of income for over half of households in our sample. They are higher among larger and wealthier households, and households whose primary source is not at home. Even households with unprotected private wells or connections to an intermittent piped network spend money on water storage containers and on treating water they recognize as unsafe.

Water Demand Function of Residents of Delhi (India):An Empirical Analysis

This study empirically determines the residential demand for water of the sampled households of selected localities of Delhi, thus estimating the demand function to derive price and income elasticities. The coefficients of price and income elasticities are taken as key policy variables in answering the question of unreliability (quantity and quality) of Delhi Jal Board's (DJB) water supply in terms of coping costs of meeting alternate domestic technology of procuring water by the sampled residents. The econometric estimation results reveal that residents are responsive to price changes for improved and reliable water supply from DJB.

(Cost)-effectiveness of a multi-component intervention for adults with epilepsy: study protocol of a Dutch randomized controlled trial (ZMILE study).

BackgroundIn patients with epilepsy, poor adherence to anti-epileptic drugs has been shown to be the most important cause of poorly controlled epilepsy. Furthermore, it has been noted that the quality of life among patients with epilepsy can be improved by counseling and treatments aimed at increasing their self-efficacy and concordance, thus stimulating self-management skills. However, there is a need for evidence on the effectiveness of such programs, especially within epilepsy care. Therefore, we have developed a multi-component intervention (MCI) which combines a self-management/education program with e-Health interventions. Accordingly, the overall objective of this study is to assess the (cost)-effectiveness and feasibility of the MCI, aiming to improve self-efficacy and concordance in patients with epilepsy.MethodsA RCT in two parallel groups will be conducted to compare the MCI with a control condition in epilepsy patients. One hundred eligible epilepsy patients will be recruited and allocated to either the intervention or control group. The intervention group will receive the MCI consisting of a self-management/education program of six meetings, including e-Health interventions, and will be followed for 12 months. The control group will receive care as usual and will be followed for 6 months, after which patients will be offered the possibility of participating in the MCI. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) process evaluation. The primary outcome will be self-efficacy. Secondary outcomes include adherence, side effects, change in seizure severity & frequency, improved quality of life, proactive coping, and societal costs. Outcome assessments will be done using questionnaires at baseline and after 3, 6, 9, and 12 months (last two applicable only for intervention group).DiscussionIn times of budget constraints, MCI could be a valuable addition to the current healthcare provision for epilepsy, as it is expected that higher concordance and self-efficacy will result in reduced use of healthcare resources and an increased QOL. Accordingly, this study is aimed helping patients to be their own provider of health care, shifting epilepsy management from professionals to self-care by patients equipped with appropriate skills and tools.Trial registration numberNTR4484.

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities.

To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. Between August 2008 and February 2009, a cross-sectional study was conducted among all (245) smear-positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower- and middle-income quintiles (adjusted odd ratio (aOR) = 36.2, 95% CI [12.3-106.3] and aOR = 6.4 [2.8-14.6]), adverse pre-diagnosis stage (aOR = 5.4 [2.2-13.3]) and less education (aOR = 4.1[1.9-8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). Catastrophic direct costs and substantial indirect and coping costs may persist under the 'free' tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.

The economic burden of tuberculosis care for patients and households in Africa: a systematic review [Review article

To summarise the state of knowledge on the economic impact and consequences of tuberculosis (TB) diagnosis and treatment for patients/households in Africa, and to highlight any weaknesses in the work conducted to date. We systematically searched for published articles in English between 1990 and June 2010 in eight databases and the World Health Organization (WHO) website. Broad search terms were used ('tuberculosis' OR 'tuberculosis/HIV' AND 'costs' AND 'Africa'). Only studies that reported any costs of TB care for patients/households were retained. All costs were converted to 2009 USD in accordance with WHO cost analysis guidelines. Overall, 11 articles from eight countries met the inclusion criteria. Only one study met all the quality criteria for a cost-of-illness study; most of the studies focused on urban populations, reported incomplete (pre-diagnostic/average) costs, and did not report coping costs. Mean patient pre-diagnostic costs varied between US$36 and US$196, corresponding to respectively 10.4% and 35% of their annual income. Average patient treatment costs ranged between US$3 and US$662, corresponding to 0.2-30% of their annual income. Pre-diagnostic household costs accounted for 13% and 18.8% of patients' annual household income, while total household treatment costs ranged between US$26 and US$662, accounting for 2.9-9.3% of annual household income; 18-61% of patients received financial assistance from outside their household to cope with the cost of TB care. The average patient's/household's pre-diagnostic costs for TB care were catastrophic. More properly designed studies are needed among different populations throughout Africa.

When parents’ affection depends on child’s achievement: Parental conditional positive regard, self-aggrandizement, shame and coping in adolescents

We examined the idea that adolescents’ perceptions of their mothers as using parental conditional positive regard (PCPR) to promote academic achievement are associated with maladaptive self feelings and coping. A study of 153 adolescents supported the hypothesis that PCPR predicts self-aggrandizement following success and self devaluation and shame following failure, which then predict compulsive over-investment. PCPR functioned as a unique predictor of maladaptive self feelings and coping also when the effects of perceived parental conditional negative regard or psychological control were controlled for. The findings suggest that the experience of one’s mother as using conditional positive regard to promote achievement leads to a non-optimal self-esteem dynamics, in which people vacillate between feelings of grandiosity following success and self-derogation and shame following failure, which in turn promote a rigid and stressful mode of coping. Thus, the practice of PCPR, although seemingly benign, appears to carry significant emotional and coping costs for adolescents.

How valuable are environmental health interventions? Evaluation of water and sanitation programmes in India.

To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India. We combined propensity-score "pre-matching" and rich pre-post panel data on 9500 households in 242 villages located in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre-post design allowed us to use a difference-in-difference estimator to measure "treatment effect" by comparing treatment and control villages during both periods. We compared average household costs with respect to out-of-pocket medical expenses, patients' lost income, caregiving costs, time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage. Three years after programme initiation, the number of households using piped water and private pit latrines had increased by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household cash expenditures) in coping costs, but would not reduce illness costs. Poorer, socially marginalized households benefited more, in alignment with programme objectives. Given the renewed interest in water, sanitation and hygiene outcomes, evaluating the economic benefits of environmental interventions by means of causal research is important for understanding the true value of such interventions.

Coping with unreliable public water supplies: Averting expenditures by households in Kathmandu, Nepal

This paper investigates two complementary pieces of data on households' demand for improved water services, coping costs and willingness to pay (WTP), from a survey of 1500 randomly sampled households in Kathmandu, Nepal. We evaluate how coping costs and WTP vary across types of water users and income. We find that households in Kathmandu Valley engage in five main types of coping behaviors: collecting, pumping, treating, storing, and purchasing. These activities impose coping costs on an average household of as much as 3 U.S. dollars per month or about 1% of current incomes, representing hidden but real costs of poor infrastructure service. We find that these coping costs are almost twice as much as the current monthly bills paid to the water utility but are significantly lower than estimates of WTP for improved services. We find that coping costs are statistically correlated with WTP and several household characteristics.

The Costs of Inflation Revisited

Neoclassical treatments of inflation understate the costs associated with inflation, even at very low levels. A comparative institutions perspective that recognizes the epistemological properties of prices and the institutional process by which inflation takes place, reveals the costs of inflation to be both larger and more widespread than standard treatments suggest. This paper makes use of insights from Austrian economics, public choice theory, and the new institutional economics to argue that inflation imposes costs by undermining the coordinative properties of the price system. Not only are there the direct costs of increased economic error, but actors also divert resources away from direct want-satisfaction into attempts to either prevent or cope with the increased degree of uncertainty inflation imposes. These resource costs are best understood from a comparative institutions perspective, as traditional measures of economic well-being, such as GDP, cannot distinguish between exchanges that directly satisfy wants, and exchanges that are attempts to correct or prevent utility-diminishing activities. The analogy between these coping costs and rent-seeking behavior is explored. In addition, inflation imposes costs by undermining the coordinative properties of markets and inducing actors to, on the margin, prefer to seek wealth or allocate resources through the political process.

Effects of Threat Appeals on Persuasion

The purpose of this study was to demonstrate effective components of threat appeal from the viewpoint of the protection motivation theory (PMT). In Study I, 780 university students filled out the questionnaire including measures of variables specified by PMT and preventive intentions about each health or safety problem. As a result of the factor analyses and multiple regression analyses conducted to discriminate the conceptual duplication of PMT, we found that seven variables of PMT could be integrated into the following five: magnitude of threat, rewards of maladaptive response, the effectiveness of recommended coping response, self-efficacy, and costs of adaptive response. In Study II, we examined causal relationships between these five variables and persuasive effects. Five hundred forty-four university women read one of thirty-two kinds of message composed with combinations of the five variables, then rated the intentions of adopting the recommended coping response. The major results obtained were as follows: (1) Magnitude of threat, response efficacy and self-efficacy have positive relationships to persuasion, and rewards and costs have negative relationships to it. (2) Particularly, magnitude of threat and response efficacy were important elements of threat appeals, and size of an effect of magnitude of threat was mediated by response costs. Future study should improve the predictive power of PMT and reexamine a function of fear in PMT.

Estimating the Willingness to Pay for Water Services in Developing Countries: A Case Study of the Use of Contingent Valuation Surveys in Southern Haiti

Progress in improving the quality and quantity of water used by people in rural areas of the developing world has been unsatisfactory in two respects: (1) supplies that have been built are frequently neither used correctly nor properly maintained and (2) extension of improved service to unserved populations has been slow. Though this poor record is not the result of a single factor, a major impediment to improved performance is inadequate information on the response of consumers to new service options. The behavioral assumptions that typically underlie most rural water supply planning efforts are simple. It is commonly assumed that so long as financial requirements do not exceed 5% of income, rural consumers will choose to abandon their existing water supply in favor of the "improved" system. Several reviews by the World Bank, bilateral donors, and water supply agencies in developing countries have shown, however, that this simple model of behavioral response to improved water supplies has usually proved incorrect.1 In rural areas many of those "served" by new systems have chosen to continue with their traditional water use practices.

Book Review: Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs

Book Review: Burnout in the Nursing Profession: Coping Strategies, Causes, and Costs