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Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda

Overview of attention for article published in BMC Health Services Research, August 2015
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2 tweeters

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Title
Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda
Published in
BMC Health Services Research, August 2015
DOI 10.1186/s12913-015-1019-5
Pubmed ID
Authors

Agnes Nanyonjo, Benson Bagorogoza, Frida Kasteng, Godfrey Ayebale, Fredrick Makumbi, Göran Tomson, Karin Källander

Abstract

Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers' willingness to pay (WTP) for referral. Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the 'bidding game' approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Reasons for referral included having fever with a negative malaria test (46.8 %), danger signs (29.6 %) and drug shortage (37.4 %). Among the referred, less than half completed referral (45.8 %). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p < 0.001). The average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7 %, caregivers' and CHWs' opportunity costs contributed 29.2 % and 5.1 % respectively and health facility costs contributed 39.6 %. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing caregiver education level. The mean WTP for referral was higher than the average out of pocket expenditure. This, along with suboptimal referral completion, points to barriers in access to higher-level facilities as the primary cause of low referral. Community mobilisation for uptake of referral is necessary if the policy of referring children to the nearest health facility is to be effective.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 118 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Unknown 117 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 30 25%
Researcher 23 19%
Student > Postgraduate 14 12%
Student > Ph. D. Student 13 11%
Student > Bachelor 9 8%
Other 20 17%
Unknown 9 8%
Readers by discipline Count As %
Medicine and Dentistry 35 30%
Social Sciences 19 16%
Nursing and Health Professions 19 16%
Economics, Econometrics and Finance 7 6%
Agricultural and Biological Sciences 5 4%
Other 15 13%
Unknown 18 15%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 March 2021.
All research outputs
#15,140,642
of 18,912,409 outputs
Outputs from BMC Health Services Research
#5,400
of 6,368 outputs
Outputs of similar age
#174,611
of 248,632 outputs
Outputs of similar age from BMC Health Services Research
#1
of 1 outputs
Altmetric has tracked 18,912,409 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 6,368 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.2. This one is in the 6th percentile – i.e., 6% of its peers scored the same or lower than it.
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We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them