The value of informal care in the context of option B+ in Malawi: a contingent valuation approach.
Informal care, the health care provided by the patient's social network is important in low income settings although its monetary value is rarely estimated. The lack of estimates of the value of informal care has led to its omission in economic evaluations but this can result in incorrect decisions about cost effectiveness of an intervention. We explore the use of contingent valuation methods of willingness to pay (WTP) and willingness to accept (WTA) to estimate the value of informal care provided to HIV infected women that are accessing antiretroviral therapy (ART) under the Option B+ approach to prevention of mother-to-child transmission (PMTCT) of HIV in Malawi.



We collected cross sectional data from 93 caregivers of women that received ART care from six health facilities in Malawi. Caregivers of women that reported for ART care on the survey day and consented to participate in the survey were included until the targeted sample size for the facility was reached. We estimated the value of informal care by using the willingness to accept (WTA) and willingness to pay (WTP) approaches. Medians were used to summarize the values and these were compared by the Wilcoxon signed-rank test.



The median WTA to provide informal care in a month was US$30 and the median WTP for informal care was US$13 and the two were statistically different (p < 0.000). Median WTP was higher in the urban areas than in the rural areas (US$21 vs. US$13, p < 0.001) and for caregivers from households from higher wealth quintile than in the lower quintile (US$15 vs. US$13, p < 0.0462).



Informal caregivers place substantial value on informal care giving. In low income settings where most caregivers are not formally employed, WTP and WTA approaches can be used to value informal care.



NCT02005835.
Department of Economics, University of Malawi, P.O. Box 280, Zomba, Malawi. lchiwaula@yahoo.co.uk.
Levison Stanely
LS
Chiwaula
Department of Economics, University of Malawi, P.O. Box 280, Zomba, Malawi.
Gowokani Chijere
GC
Chirwa
Dignitas International, Zomba, Malawi.
Fabian
F
Cataldo
College of Medicine, University of Malawi, Blantyre, Malawi.
Atupele
A
Kapito-Tembo
University of North Carolina Project, Lilongwe, Malawi.
Mina C
MC
Hosseinipour
Dignitas International, Zomba, Malawi.
Monique
M
van Lettow
Lighthouse Trust, Lilongwe, Malawi.
Hannock
H
Tweya
University of North Carolina Project, Lilongwe, Malawi.
Virginia
V
Kayoyo
College of Medicine, University of Malawi, Blantyre, Malawi.
Blessings
B
Khangamwa-Kaunda
Dignitas International, Zomba, Malawi.
Florence
F
Kasende
Lighthouse Trust, Lilongwe, Malawi.
Clement
C
Trapence
Lighthouse Trust, Lilongwe, Malawi.
Salem
S
Gugsa
University of North Carolina Project, Lilongwe, Malawi.
Nora E
NE
Rosenberg
Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.
Michael
M
Eliya
Lighthouse Trust, Lilongwe, Malawi.
Sam
S
Phiri
D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D017028:Caregivers / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D010342:Patient Acceptance of Health Care; D005791:Patient Care / Q000191:economics* / Q000592:standards; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors
D019380:Anti-HIV Agents
Informal care; Malawi; Option B+; PMTCT; Willingness to Accept; Willingness to Pay