Choice of providers for treating a neglected tropical disease:an empirical analysis of kala azar in Nepal

Objective:To examine the choice of healthcare providers for treating kala azar(KA) in Nepal. Methods:Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts.The survey collected information from more than 25 percent of total KA cases in the country.For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider,a multinomial logit model was defined with five alternative options with self care as the reference category.Results:The empirical model found that price of medical care services,income of households,knowledge of patients on KA and KA treatment,borrowing money,age of patient,perceived quality of provider types,etc.determine the likelihood of seeking care from the alternative options considered in the analysis.All variables have expected signs and are con.vstent with earlier studies.The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes,even for a severe disease like KA.Using the empirical models, we have analyzed two policy instruments:demand side financing and interventions to improve the knowledge index about KA.Conclusions:Due to high price elasticity of KA care and high spillover effects of KA on the society,policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

Background:Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options.This paper makes an attempt to understand how and why consumers make specific decisions,what motivates them to adopt a specific health intervention,and what features they find attractive in each of the options.Method:The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers.Information was collected through focus group discussions and in-depth interviews.Results:The results suggest that the decision making related to seeking healthcare for Kala Azar(KA)treatment is a complex,interactive process.Patients and family members follow a well-defined road map for decision making.The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors,such as indigenous knowledge,healthcare alternatives,and available resources.Household and individual characteristics also play important roles in facilitating the process of decision making.The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care.Conclusion:The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion.Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs,and then modifying it to show the influences of indigenous knowledge,healthcare alternatives,and available resources.