Willingness-to-Accept and Willingness-to-Pay Ratios of Prevention of Mother-to-Child Transmission Services in a Nigerian Hospital: A Cross-Sectional Contingent Valuation Study

Value Health Reg Issues. 2019 Sep:19:112-121. doi: 10.1016/j.vhri.2019.05.001. Epub 2019 Aug 9.


Background: In Nigeria, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome treatment and care services, prevention of mother-to-child transmission (PMTCT) inclusive , are accessed free of charge by patients due to finanacial support from donor agencies. This trend may not be sustainable in the future due to the present global economic realities. Hence, there is the need to ascertain the readiness of PMTCT patients to pay for such services.

Objectives: This contingent valuation study determined the willingness-to-accept (WTA), willingness-to-pay (WTP), and WTA-to-WTP ratios of PMTCT services among clients in a Nigerian tertiary hospital.

Methods: This was a cross-sectional questionnaire-based study. All adult PMTCT patients who had never paid for any component of the services participated in the study. The questionnaire measured their WTP and WTA for the following components of PMTCT: primary prevention of HIV, prevention of unintended pregnancy in HIV-positive women, follow-up treatment and support, and therapeutic interventions around delivery. The WTP and WTA for PMTCT drugs and specialized clinical pharmacy services were also measured. The WTA-to-WTP ratios, income effects, and income elasticity were determined for all services. Questions were posed using Naira (N) ($1 = N250, at the time of the study).

Results: Respondents aged 25 to 34 years comprised 80.8% of the population, whereas 80.8% were married. The mean amounts of WTA and WTP for services involving primary prevention of HIV was N543 000 and N18 600, respectively. Its WTA-to-WTP ratio and approximate income effect were 29.19 and -28.19, respectively. These variables were associated with WTP for some services: level of education with PMTCT follow-up treatment and support (P=.046), trimester of pregnancy with primary prevention of HIV (P=.002), correspondent's residence with specialized clinical pharmacy services (P=.003), and time spent to reach facility with primary prevention of HIV (P=.002).

Conclusions: All services had high WTP, WTA-to-WTP ratios, and income effects, with inelastic income elasticity coefficients: patients in the Nigerian hospital attribute high value to all PMTCT services.

Keywords: HIV/AIDS; contingent valuation; prevention of mother-to-child transmission; willingness to accept; willingness to pay.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • HIV Infections / prevention & control*
  • Health Expenditures*
  • Humans
  • Income
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Nigeria
  • Patient Acceptance of Health Care*
  • Pregnancy
  • Surveys and Questionnaires