Background and Objective
Strengthening the urban primary healthcare system is essential for delivering need-based services to the rapidly growing low-income urban population in Bangladesh. This study examined the preferences of slum dwellers for primary healthcare providers under hypothetical minor and major illness conditions.
Methods
A discrete choice experiment was conducted among 304 slum dwellers in Dhaka, Bangladesh, in January-February 2024. Six final attributes (time to reach healthcare centre, waiting time to see a provider, recommendation from neighbours/relatives, type of healthcare provider, consultation fee and medicine expenditure) were identified through a systematic review, focus group discussions and key informant interviews, and finalised through a community ranking exercise and expert consultation. A Bayesian D-efficient design was used to construct choice sets, each presenting two hypothetical primary healthcare providers and an opt-out option; respondents completed each choice set for minor and major illnesses. Data were analysed using mixed logit models (in preference and willingness-to-pay space), relative importance analysis and latent class analysis.
Results
Consultation fee had the highest relative importance for minor illness and type of healthcare provider for major illness. An MBBS/qualified doctor for minor illness and a senior/experienced doctor for major illness were strongly preferred over non-qualified providers. Utility decreased significantly with longer travel time (60 min) and waiting time (30 min), and higher consultation fees (p < 0.001). Compared with no recommendation, a negative recommendation significantly reduced utility for major illness, and a positive recommendation significantly increased utility for minor illness. Free medicines and a 50% discount on medicines significantly increased utility relative to no discount in both conditions (p ≤ 0.004), with higher utility for free medicines.
Conclusions
Consultation fee was the most important attribute for minor illness and provider type for major illness; respondents also valued qualified providers, shorter travel and waiting times and free or discounted medicines. Deploying qualified doctors in accessible community facilities, reducing consultation fees and subsidising medicines may improve the uptake of primary healthcare among urban slum dwellers in Bangladesh. These findings can inform patient-centred primary healthcare policy for low-income urban populations.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)