This thesis addresses the issue of malaria care financing as a strategy in the control of malaria. Household malaria care seeking behaviour and the factors affecting the choice of treatment options under a user fees scheme, as well as ex ante demand for malaria care at formal health care facilities are investigated. Specifically, the study investigates the effect of prices, income, proximity and other socio-economic factors on malaria care seeking behaviour. The contingent valuation method (CVM) is used to investigate households' willingness to pay for malaria insurance.
The data were collected by means of a face-to-face interview of households conducted at Amasaman and Hohoe, Ghana between July and November 1997. The data were supplemented with interviews of key informants comprising health care workers and local community leaders.
Two types of households were sampled: households for whom malaria cases
were self-reported (household level sample) and households whose malaria status had been clinically diagnosed at health care facilities (facility level sample). Simple random sampling was used to select the first sample, while convenience sampling was used to select the second sample.
The results of the malaria care demand model indicate that facility price, travel time to facility, number of children, education and number of healthy days are significant variables that affect the demand for malaria care provider. The results also suggest that malaria care services provided at public and private facilities, and drug stores are close substitutes. In general, demand for provider service is inelastic with respect to time and money prices for the combined sample. One of the empirical contribution of this thesis is in comparing demand for malaria care in urban (Amasaman) and rural (Hohoe) communities. In this respect, demand is relatively more elastic with respect
to travel time in urban communities compared to rural communities.
The results of the CVM study indicate that there is a high level of willingness among households (about 98 per cent of households in two study communities) to join and participate in a malaria insurance programme. Household income and residential location (whether in an urban or rural areas) and household head's primary occupation are some of the factors that significantly affect household willingness to pay and participate in the malaria insurance programme. The mean premium for the household level sample was ¢2,566.70 per month, while the mean premium for the facility level sample was ¢2,502.44 per month. A comparison of the estimated marginal effects of the statistically significant variables indicated a stronger responsiveness among the household level sample with respect to say, income than the facility level sample.
A number of policy related
issues arise from this study. Facility price was found to have a significant effect on demand for malaria care in both rural and urban communities. Households in urban communities are more likely to use private health care facilities, while those in rural communities are more likely to use public facilities. This difference could be explained by facility price and income differences in the two areas. There is therefore the need for not only for more health facilities in the rural areas, but also some control of prices.
With respect to health care financing, the study reveals support for the concept of a malaria insurance programme. This reflects the public's concern about malaria, in particular, and health care, in general. The study results indicate that household income, location (or residence), and primary occupation are important factors that should be considered designing the NHI scheme. In view of the widespread poverty and high proportion of
self-employment, consideration needs to be given to designing a scheme that is appropriate and affordable. One of the benefits of a malaria insurance is its likelihood of significantly reducing self-treatment in favour of treatment at clinics and hospitals.