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«Market Research for Nairobi Eye Hospital (NEH) to Increase Access to Eye Care Services for the Working Poor in Nairobi and its Environs, Kenya ...»

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Market Research for Nairobi Eye Hospital (NEH) to Increase Access to Eye Care Services for the Working Poor in

Nairobi and its Environs, Kenya

Private Sector Innovation Programme for Health (PSP4H)

Market Research for Nairobi Eye

Hospital (NEH) to Increase Access to

Eye Care Services for the Working

Poor in Nairobi and its Environs

Private Sector Innovation Programme

for Health (PSP4H)

Prepared for

Department for International Development

(DFID)

29th June 2015

Market Research for Nairobi Eye Hospital (NEH) to Increase Access to Eye Care Services for the Working Poor in Nairobi and its Environs, Kenya Private Sector Innovation Programme for Health (PSP4H) List of Acronyms and Definitions CME Continuous Medical Education DFID Department for International Development FGD Focus Group Discussion IDI In-Depth Interview KNH Kenyatta National Hospital LSM Pan African Living Standard Measure M4P Making Markets Work for the Poor NEH Nairobi Eye Hospital NGO Non-Governmental Organization PSP4H Private Sector Innovation Programme for Health RSA Research Solutions Africa UHEAL Upper Hill Eye and Laser Centre

DEFINITIONS:

Visual Acuity – Defined as what the patients sees at 6 meters vs what a normal person would see. E.g. 6/9 means the patient can read at 6 meters what a normal person can read at 9 meters. 6/60 means that the patient is only able to read at 6 meters what a normal person can read at 60 meters away.

Normal Vision – Is defined as vision better than 6/18 Visual Impairment – Is vision worse than 6/18 but better than 6/60 Severe Visual Impairment – Is vision of 6/60 or worse but better than 3/60 Blindness – Is vision of 3/60 or worse Cataract – It is the clouding of the natural lens in the Eye. Cataract is the most common cause of blindness nationally and globally and contributes to approximately 50% of blindness.

Market Research for Nairobi Eye Hospital (NEH) to Increase Access to Eye Care Services for the Working Poor in Nairobi and its Environs, Kenya Private Sector Innovation Programme for Health (PSP4H) Executive Summary The Private Sector Innovation Programme for Health (PSP4H) is a UK Government-funded action research project exploring a market systems approach to development known as ‘Making Markets Work for the Poor’ (M4P); with this technical approach, analysis informs market engagement. Research Solutions Africa (RSA) was requested to conduct a market research to ascertain/determine the magnitude of eye problems, understand consumer knowledge, attitudes, practices and health seeking behavior with regard to eye care services in Kenya. This study was done to inform the design of improved approaches to marketing of services offered by Nairobi Eye Hospital with the goal of increasing the number of working poor accessing eye healthcare at the facility.

The study employed a cross sectional approach in the study design, using both qualitative and quantitative methodologies to include views from both working poor with eye problems and eye care providers. The quantitative study included a total 720 face-to-face interviews which were conducted across four sub-regions within Nairobi, Limuru and Kiambu. A target household was defined as a household where a household member has experienced eye problems. Numeration areas were residential locations of low-income earners. The qualitative study involved In-depth Interviews and Focus Group Discussions (FGD), using face-to-face interviews with approved In-depth Interview (IDI) and FGD guides respectively. All the discussions were audio recorded.

Summary of Key Findings are highlighted below:

 Itching, redness of the eye, tearing and pain are reported to be the most common eye problems suffered by the urban poor coming from Nairobi and its environs The survey revealed that itching, redness of the eye, tearing and pain are reported to be the most common eye problems suffered by the urban poor coming from Nairobi, Limuru and Kiambu, especially among people aged between twenty-one and forty. These common eye problems correlate with those reported by eye care providers.

 Low level of awareness towards local eye care providers The study confirms that people who have eye problems but never sought treatment are less aware of the major eye health providers around them, compared to their counterparts who sought eye treatments either for themselves or for patients they take care of. Only 3% of eye patients and 6% of care-takers of eye patients reported that they have not heard of any eye care providers in Nairobi while 29% of people who never sought treatment for their eye problems were not aware of any eye care providers in Nairobi and its environs.

 Financial burden perceived as the main obstacle for eye care seeking behaviors in general One of the main findings of the study suggests that financial constraint is the main reason people who need eye treatments turn away from receiving eye care services at major eye hospitals. Among people who have eye problems but never sought treatments, 77% of them said they did not seek treatment because of lack of finance; the financial burden seemed to affect subsistence farmers more than people with higher skills.

However, based on what was revealed in the survey, we noticed that for people who have sought eye treatments, a high percentage of respondents pay for eye services including consultation, glasses and medication which are the most common services they have sought.





When it comes to their willingness to pay for services in relation to eye problems, however, the percentage decreased.

 Low payment is preferred by all groups of respondents for consultation services and cataract surgery When asked about preferred prices for different eye services, most respondents are only willing to pay for consultation fees of less than Ksh. 500. For glasses, preference for price is

–  –  –

less concentrated as 20% of eye patients and 10% of the care-takers are willing to pay for glasses with a price at the top range (over Ksh. 2500). Very few people are willing to pay market rate (about Ksh. 30,000) for cataract surgery which might be because of the relatively low morbidity, cost of the service and the perceived high risk of post-operation complications.

 The NEH Model is favored by a large majority of the working poor with eye problems The study shows that respondents across all survey groups expressed positive attitudes towards upgrades of eye care facilities through provisions of accommodation, a chain of vision centers in three targeted locations, eye glasses services and cataract surgery service.

Compared to other services, however, the willingness to use cataract surgery is relatively low.

Some respondents reported that it would not be likely for them to use the cataract surgery service included in the NEH Model because “it will be too expensive”, they are “too young to have cataract surgery” and are “afraid of going blind”.

 Radio remained the most common channel of information for both care seekers and people with eye problems but never sought for treatments The survey also showed the pattern of how people having eye problems gain access to information related to eye healthcare. It was suggested that radio is the most commonly used and preferred channel for people having eye problems to gain access to eye care information.

TV reported to be popular for access to healthcare information too while magazine, internet and social media remained the least popular channels. A considerable large proportion of respondents also received information about eye healthcare from family and friends, who are also the actors that eye services seekers would consult with when selecting eye health facilities for eye treatments.

–  –  –

Table of Contents List of Acronyms and Definitions

Executive Summary

Background

About Nairobi Eye Hospital

1.1 Problem Definition

1.2 Objectives of the Assessment

1.3 Methodology

2.1 Research Design

2.2 Training of Numerators

2.3 The Targeted Population

2.4 Data Collection and Tools Used

2.4.1 Data Collection Process

2.4.2 Tools Used During the Survey

2.5 Sample Size

2.6 Challenges Faced during Data Collection

Common Eye Problems amongst Low-income Earners in Nairobi.... 13 Overall Trend of Common Eye Problems

3.1 Frequency of Common Eye Problems (by Age)

3.2 Selection of Eye Care Services and Fee-Paying Practices

4.1 Who Pays for Eye Care Services?

4.2 Type of Eye Services Patients Pay for

4.3 Type of Eye Services Patients Pay for (By Age)

4.4 Prices Paid for Each Type of Eye Services

4.5 Willingness to Pay for Eye Services and Perceived Reasonable Prices for Eye Services

4.6 Perceived Reasonable Prices for Eye Services

4.6.1 Consultation

4.6.2 Glasses

4.6.3 Cataract Surgery

Knowledge about Local Eye Care Providers

Total Awareness of Local Eye Health Providers

5.1 Awareness of Local Eye Health Providers (By Location)

5.2 Decision-Making for Eye Care Seeking Behaviors

Popular Health Facilities for Eye Care Seekers

6.1 Popular Health Facilities for Eye Care Seekers (By Location)..................25 6.2 Reasons for Choosing Eye Services Providers

6.3 Social Influence during Decision-Making in Eye Care Seeking................26 6.4 Financial Influence during Decision-Making in Eye Care Seeking..........27 6.5 6.6 Obstacles for Not Seeking Eye Care Services for the Most Recent Case

Reasons for Never Seeking Eye Care Services (By Skill-Level)...............30 6.7 Provider’s View: Challenge in Providing Eye Care Services................ 31 Specific Challenges for Providers

7.1 Specific Challenges for Patients

7.2 Patient Satisfaction of Existing Eye Care Facilities

–  –  –

8.1 Patient Satisfaction

8.2 Likelihood for Recommendation

8.3 Instant Service for Eye Treatments

8.3.1 Patients’ View

8.3.2 Providers’ View

8.4 Referral for Eye Treatments

8.4.1 Patients’ View

8.4.2 Providers’ View

Preference for NEH Model

Preference for NEH Model

9.1 Willingness and Likelihood in Usage

9.2 10 Media and Sources of Information

Channels for Access to Eye Care Information

10.1 Preferred Channels for Access to Eye Care Information

10.2 Frequency of Accessing General Information about Healthcare.........39 10.3 10.3.1 For Eye Care Seekers

10.3.2 For People with Eye Problems but Never Sought Treatments

11 Improvement in Providing Eye Care Services – Providers’ View....... 41 Strategies

11.1 Foreseeable Threats in the Eye Care Services Segment

11.2 Eye Care Education Materials

11.3 12 Conclusions

Main Findings

12.1 Strategy Recommendations

12.2 References

List of Tables

Table 7-1 List of Popular Eye Hospitals/Clinics (Specified)

Table 7-2 Reasons for Choosing Eye Service Providers

Table 9-1 Patient Satisfaction towards Major Eye Hospitals

Table 10-1 Likelihood in Usage of Services provided by NEH Model

Table 11-1 Frequency of Accessing General Information about Healthcare (Eye Care Seekers)

Table 11-2 Frequency of Accessing General Information about Healthcare (for people with eye problems but never sought for treatments)

List of Figures

Figure 1 Frequency of Common Eye Problems

Figure 2 Frequency of Common Eye Problems (By Age)

Figure 3 Frequency of Paying for Eye Care Services (Eye Patients)

Figure 4 Frequency of Paying for Eye Care Services (Care-Takers of Eye Patients)............ 15 Figure 5 Services that Eye Patients and Care-Takers of Eye Patients Pay for

Figure 6 Type of Eye Services Patients Pay for (Consultation)

Figure 7 Type of Eye Services Patients Pay for (Glasses)

Figure 8 Type of Eye Services Patients Pay for (Medication)

Figure 9 Prices Paid for Eye Services (Consultation)

Figure 10 Prices that are paid for Eye Services (Glasses)

–  –  –

Figure 11 Prices Paid for Eye Services (Medication)

Figure 12 Willingness to Pay for Eye Services

Figure 13 Willingness to Pay for Eye Services (By Type)

Figure 14 Perceived Reasonable Fee for Consultation

Figure 15 Perceived Reasonable Fee for Glasses

Figure 16 Perceived Reasonable Fee for Cataract Surgery

Figure 17 Awareness of Local Eye Care Providers

Figure 18 Awareness of Local Eye Health Providers (By Location)

Figure 19 Popular Health Facilities for Eye Care Seekers

Figure 20 Popular Health Facilities for Eye Care Seekers (By Location)

Figure 21 Frequency of consulting others about Choices over Eye Hospitals

Figure 22 Person for Consultation about Choices over Eye Hospitals

Figure 23 Sources of Payment for Eye Care Services

Figure 25 Sources of Money Borrowing for Eye Treatments

Figure 26 Obstacles for Not Seeking Eye Care Services for the Most Recent Case............. 29 Figure 27 Reasons for Never Seeking Eye Care Services (By Skill-Level)

Figure 28 Likelihood for Recommending Major Eye Hospitals

Figure 29 Percentage of Attending Eye Care Services upon Appointments

Figure 30 Percentage of Obtaining Instant Services at Eye Hospitals

Figure 31 Service Duration for the Most Recent Eye Treatment Experience

Figure 32 Percentage of Attending Eye Care Services upon Referral (Patients’ View).......... 35 Figure 33 Preference for NEH Model

Figure 34 Channels for Access to Eye Care Information

Figure 35 Preferred Channels for Access to Eye Care Information

–  –  –



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