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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 139 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Unknown 138 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 34 24%
Researcher 24 17%
Student > Postgraduate 15 11%
Student > Ph. D. Student 13 9%
Student > Bachelor 10 7%
Other 24 17%
Unknown 19 14%
Readers by discipline Count As %
Medicine and Dentistry 38 27%
Nursing and Health Professions 21 15%
Social Sciences 19 14%
Agricultural and Biological Sciences 7 5%
Economics, Econometrics and Finance 7 5%
Other 20 14%
Unknown 27 19%

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
#16,534,367
of 20,560,385 outputs
Outputs from BMC Health Services Research
#5,817
of 6,879 outputs
Outputs of similar age
#178,842
of 252,027 outputs
Outputs of similar age from BMC Health Services Research
#1
of 1 outputs
Altmetric has tracked 20,560,385 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 6,879 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.4. This one is in the 7th percentile – i.e., 7% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 252,027 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 16th percentile – i.e., 16% of its contemporaries scored the same or lower than it.
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