Factors influencing choice of provider for Malaria treatment: Evidence from a lowincome area in Tanz

1
Factors influencing choice of provider for
Malaria treatment Evidence from a low-income
area in Tanzania F Matovu, V. Wiseman, B.
McElroy, M. Kongongo, L. Conteh, W. Mwengee
Background Understanding factors which influence
choice of health care provider is important in
designing appropriate treatment. Studies in this
area have identified financial, structural,
organizational and cultural factors as key
aspects that influence choice of provider
(Barttolome Vosti, 1995 Asenso Okyere et al,
1997 Mensah, 2000 Goddard Smith, 2001
Hjortsberg Mwikisa, 2002). Asenso Okyere et al
(1997) showed that the patients choice between
self-medication, drug store, government facility
or private/mission facility in rural Ghana was
influenced by facility price, travel time,
waiting time for treatment, drug availability,
and the patients education, age and gender and
household income. Bartolome and Vosti (1995)
revealed that an individuals choice between
treatment source (i.e. public and private
clinics) in Brazil. Private treatment was shown
to be highly price sensitive and, to a lesser
extent, wealth sensitive. Moreover, rural
individuals were more likely to choose private
treatment compared with urban patients. Mensah
(2000) examined the effect of socio-economic
factors on the demand for malaria treatment. A
patients age, total expenditure, ethnicity,
treatment costs and participating in a local
credit scheme significantly affected the choice
of treatment.
Chart 1 Choice of health care provider by
severity of illness ()
Study Aim This presentation is about factors
influencing choice of health care provider for
treatment of malaria to provide insights into the
factors influencing treatment-seeking behaviour
of households. This is part of a wider study
which investigated the socioeconomic determinants
of demand for malaria treatment and prevention in
Tanga district, North-eastern Tanzania. Issues
explored included choice of health care
provider, timing of treatment, and actual
expenditures for malaria/fever treatment and
prevention, as well as other illnesses.
Methods Stratified cluster sampling was used to
select 1600 households. Clusters were stratified
by geographic location. Household heads were
interviewed about their consumption and
expenditure on malaria treatment during the 2
weeks period prior to the survey. Interviews were
staggered over a 12-month period to capture the
effects of seasonality on expenditure. The
analysis provides the distribution of health care
provider choice by severity of malaria, and
reasons for provider choice by health care
provider, and by location.
Chart 1 (above) shows that drug shops
dispensaries and kiosks were the dominant
providers consulted followed by health centres.
Of particular interest, the proportion of
consultations with formal health care providers
increased with severity of illness -
consultations increased from 16 for mild cases
to 37 for severe cases for dispensaries and from
3 to 9 for hospitals respectively. This
emphasises the households preference to consult
better equipped higher-level health facilities
for complicated malaria cases other things being
equal.
Results The results show that 51.3 of households
reported an episode of fever of which 94 percent
had sought treatment from a health provider.
Chart 1 show the distribution of choice of health
care provider by severity of malaria/fever. The
higher proportion of consultations at a
traditional healer for severe malaria as compared
with mild and moderate cases is due to the fact
that severe malaria, characterised by
convulsions, is commonly associated with evil
spirits, and a traditional healer becomes the
first point of contact, especially when children
are involved. de Savigny et al (2004) have
reported similar household health care seeking
behaviour for complicated malaria in
Tanzania. Table 1 shows the reasons behind
choice of health care provider for urban and
rural respondents. Overall, proximity to a health
care provider (31.2), availability of drugs
(19) availability of Blood test facility (11),
inexpensive drugs/services (10) and,
qualification of staff (9) are the key factors
influencing choice of provider, and therefore
influence treatment seeking behaviour for
malaria/fever treatment in the study area. A
similar trend is observed for both rural and
urban households. Chart 2 highlights the
reasons for choice of provider by severity of
illness. The cost of treatment becomes less and
less important with severity of malaria, while
the importance of quality of care, (reflected by
qualified medical staff, good reputation of
facility, and support for the sick) increases
with severity of illness. Good personal
experience with a facility also becomes more
significant with severity of illness. While
proximity to a health care provider remains a key
factor overall, its significance slightly reduces
with severe malaria, reflecting the tendency for
households to by-pass lower-level facilities in
search of better quality of care at higher-level
distant facilities. A similar pattern emerges
when reasons for provider choice are analysed by
facility type. As shown in table 2, availability
of drugs and cost of treatment are significant
considerations for choice of provider for both
formal and non-formal health care
providers. Proximity is more significant for
lower-level health care providers such as kiosks
and drug shops while qualification of staff and
availability of laboratory tests are key factors
for choosing to go to health centres and
hospitals.
Table 1 Reasons for choice of provider by Rural
and Urban Respondents ()
Discussion and conclusion These results show that
financial cost of accessing health care is a key
factor influencing choice of provider for malaria
treatment in low-income areas, as indicated by
the importance attached to cost of drugs and
proximity to health facility, which influences
travel time and transport cost. The other key
factor is perceived quality of services reflected
in terms of qualification of staff, availability
of drugs and, reputation and personal experience
with the facility. These results emphasise the
importance of financial costs (direct and
opportunity cost of time to the facility) and the
organizational structure of services as important
influences on the decision as to where households
seek treatment. From a policy point of view,
there is a need to minimise the financial costs
borne by household in accessing malaria
treatment, partly by providing services closer to
communities, as well as the direct cost of
treatment at the facility. Interventions such as
promotion of home-based care, mobile health
services and, outreach clinics are options to
reduce the financial cost of access related to
travel time and transport costs. Moreover,
improving the quality of health services is vital
for effective malaria treatment at the household
level as reflected by the importance attached to
qualification of staff, availability of
laboratory tests, availability of drugs and
support for the sick in influencing choice of
provider. This study is relevant in informing
health planners about the factors constraining
treatment seeking for malaria in low-income
areas and their implications for reforming
health care delivery systems.
Source Own computations from survey data
Table 2 Reasons for choice of health care
provider by facility type
Source Own computations from survey data