Background and Objectives:As facilities are being prepared for the implementation of National Health Insurance (NHI) in South Africa, there is a pressing need to understand how the public equates the provision of health services at Primary Health Care (PHC) centres with monetary value. Accordingly, this exploratory study was designed to ascertain the willingness to pay (WTP) for public primary healthcare services in South Africa and to identify factors that influence the WTP. Methods:The study was conducted in Cape Town, South Africa, among 453 persons presenting at two public primary health care centres, namely Bothasig Community Day Centre (CDC) and Goodwood CDC. The study used the contingent valuation range methodology. Descriptive statistics, multiple logistic and tobit regression analyses were conducted to assess demographics, socio-economic, and health access factors that influence WTP. Results:Overall, 60% of participants were willing to pay for services offered at the PHC facilities. The average willingness to pay for all participants was 49.44 ZAR, with a median of 25 ZAR. The multiple logistic regression for grouped facilities showed unemployment, public transport, and the facility attended to be significant while public transport, facility visits, and facility attended were the only significant variables in the tobit model. There was less willingness to pay for those unemployed in comparison with students, those using public transport rather than walking, those frequenting the facilities more than first-time visitors and those attending Goodwood facility in comparison with Bothasig. Conclusion:This study revealed factors related to the participants' WTP and to their willingness to contribute towards the health service, though at very low amounts. Understanding the economic value placed upon a service provided in a facility is essential in decision-making for quality care A c c e p t e d M a n u s c r i p t improvements, especially as the South African health system is making the facilities ready for NHI.

Objectives: To date, there has been scant research on patient input regarding the desirable characteristics of healthcare facilities. This study uses the nominal group technique (NGT) to develop a discrete choice experiment (DCE) aimed at identifying and prioritizing, from the patient's perspective, essential characteristics for choosing public health facilities in Cape Town, South Africa.Methods: Four focus group discussions were conducted, including a total of 21 patients or their parents/companion at Bothasig and Goodwood community day centers (which offer primary care within substructure) in Cape Town. The group discussions followed the steps of NGT guidelines. At each facility, the frequency of an attribute being within the top 5 was determined, a weighted ranking was calibrated, and a subgroup analysis was performed.Results: The 6 most important attributes in choosing a facility were "treatment by a doctor/(family physician)" (66.7%), "distance to the community day center" (61.7%), "availability of medication" (61.7%), "confidentiality during treatment" (57.7%), and "waiting time" and "treatment by a nurse." The weighted results showed that distance was the most important, followed by treatment by the doctors, treatment confidentiality, availability of medication, and waiting time and treatment by a nurse. Conclusion:This study confirms the feasibility and value of the NGT in identifying and prioritizing the attributes for a DCE. The NGT can be used to elicit patient preferences and, when used together with a DCE, can enhance information quality and quantity for decision making in tandem with patient satisfaction and experiences.

Background: Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. Methods: This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women’s questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). Results: The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (−0.0294) and least intense in Burundi (−0.2206). Conclusions: This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

Understanding patients’ preferences for health facilities could help decision makers in designing patient-centered services. Therefore, this study aims to understand how patients’ willingness to trade for certain attributes affects the choice of public health facilities in the Western Cape province of Cape Town, South Africa. A discrete choice experiment was conducted in two community day centers (CDCs). Patients repetitively chose between two hypothetical health facilities that differed in six attributes: distance to facility, treatment by doctors vs. nurses, confidentiality during treatment, availability of medication, first visit (drop-in) waiting times, and appointment waiting times. The sample consisted of 463 participants. The findings showed that availability of medication (50.5%), appointment waiting times (19.5%), and first visit waiting times (10.2%) were the most important factors for patients when choosing a health facility. In addition, respondents preferred shorter appointment and first visit waiting times (<2 h). These results identified important characteristics in choosing public health facilities in Cape Town. These public health facilities could be improved by including patient voices to inform operational and policy decisions in a low-income setting.