Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment.
OBJECTIVE
We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.


METHODS
Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters.


RESULTS
A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%.


CONCLUSIONS
In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.
Kruk
Margaret E
ME
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. mkruk@umich.edu
Paczkowski
Magdalena
M
Mbaruku
Godfrey
G
de Pinho
Helen
H
Galea
Sandro
S
D000328:Adult; D001294:Attitude to Health; D002755:Choice Behavior; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania