Households' willingness to pay and associated factors for the nutrition services provided to pregnant women at maternity waiting homes in East Wollega, Western Ethiopia

Abstract

Background Maternity waiting home is a residential facility located near qualified medical facilities where pregnant woman can wait to give birth and provided a nutrition service.Lack of access to obstetric services is one of the main causes of the high incidence of maternal and newborn deaths. In Ethiopia, Most (86%) of the Maternity waiting homes had no budget allocated from government funds and there is lack of revenue for the long term sustainability of the nutrition services at Maternity waiting homes.Therefore, this study is important to sustain the services provision to pregnan mothers at the maternity waiting homes. Objective: The study aimed to identify an average annual maximum amount of households’ willingness to pay and its associated factors for the nutrition service provided to a pregnant women staying at the Maternity waiting homes in East Wollega Zone of Oromia National regional state, Ethiopia, September 2018. Methodology: A community based cross sectional study design using double bounded dichotomous choice contingent valuation method was used. The required sample size was determined by using single population proportion. Data entry and analysis were made using EpiData version 3.1 and SPSS for windows version 20 software respectively. Descriptive statistics of frequency, binary and multiple logistic regression analysis were performed. The association between explanatory variables and outcome variable were presented by an AOR and confidence interval. Results: A total of 845 respondents included in the study making a response rate of 98%. Majority 80.8% of the respondents reported the seriousness of distance problem to the pregnant women and all (100%) of the respondents reported the importance of the service. About 94.3% of them were willing to pay above the currently paid price. The annual median maximum amount of willingness to pay for the service was 15ETB (US$0.55) per year per household. The factors significantly associated with willingness to pay for the nutrition service, marital status (being married: AOR=3.533, 95% CI=1.007-12.39), average monthly income (median monthly income 1000ETB: AOR=3.287, 95%CI=1.194-9.049). More over, distance from the health facility (at less than 5KM: AOR = 3.64, 95%CI = 1.256-10.55) and availability of food (AOR=3.714, 95%CI=1.331-10.364), enough beddings (AOR=5.353, 95%CI=2.207- 13.010) and availability of cooking facilities (AOR=4.044, 95%CI=1.353-12.088) at a maternity waiting homes were found to be predictors of maximum willingnessss to pay. Conclusion and Recommendation: Maximum willingness to pay is mainly influenced by factors such as: Marital status, monthly income, and distance, availability of food, beddings and cooking facilities at maternity waiting homes. Majority of the respondents reported the seriousness of distance problem and the importance of the service. Almost all of the respondents were interested in and needed to support the services. The annual median maximum amount of willingness to pay per year per household was higher than the currently paid price. Therefore, there should be consideration in the availability of supplies and equipments at maternity waiting homes and in amount of price to be paid per year per household in order to strengthen the long-term financial sustainability of the service.