Tobit regression
Table
6 shows that age was negatively related to altruistic WTP (p < 0.05). However, years of schooling, being a big business person, prior experience of paying for contraceptives and socioeconomic status had statistically significant effects on altruistic WTP (p < 0.05). Hence, the higher a person’s SES and the more years spent in school, the more the level of altruistic WTP. Table
6 also shows that being employed by government and been a divorcee were positively, although marginally related to altruistic WTP. Females were more altruistic than men. There was no evidence of multicollinearity between the independent variables. The regression was statistically significant.
Table 6
Tobit regression analysis showing relationship between altruistic WTP and independent factors
Socio-economic status (SES) | .283 | 0.338 | 0.0001 |
Geographic location of respondent (0 = rural; 1 = urban) | .089 | .097 | 0.356 |
Status in household | - .054 | .170 | 0.753 |
Number of household residents | -.003 | .014 | 0.843 |
Sex (0 = female; 1 = male) | -.633 | .351 | 0.071 |
Age | -.030 | .007 | 0.0001 |
Years schooling | .050 | .010 | 0.0001 |
Subsistence farmer | .012 | .244 | 0.962 |
Petty trader | .013 | .129 | 0.918 |
Government worker | .332 | .172 | 0.054 |
Employed in the private sector | .047 | .180 | 0.795 |
Doing big business | .325 | .148 | 0.028 |
Other occupational groups | .130 | .180 | 0.471 |
Married | -.114 | .254 | 0.653 |
Divorced | .991 | .591 | 0.093 |
Separated | .133 | .552 | 0.810 |
Single | -.251 | .310 | 0.417 |
Had previously paid for any contraceptive | .799 | .107 | 0.0001 |
The study has shown that an appreciable level of altruism for scaling up access to modern contraceptives exists in Nigeria. It was found that many respondents across all the states were willing to contribute some money so that the very poor would be provided with modern contraceptives and the average amount of money that people were willing to contribute annually was 650 Naira (US$4.3). However, the average amounts of money that people were willing to contribute to ensure community solidarity (altruism) differed by states, urban-rural divide and socio-economic status.
The fact that there were high levels of willingness of respondents to contribute varied amounts of money so that the poor can have free access to modern contraceptives shows that there is room for community solidarity to ensure that the very poor also benefit from modern contraceptives. This is in line with the high sense of solidarity and social justice that exist in many Nigerian communities.
The implication of the high level of altruistic WTP is that in risk pooling through community financing mechanisms such as community-based health insurance (CBHI), there could be contributions of premium by the people in higher SES quintiles so that the very poor could be enrolled and benefit from the services. This is especially pertinent as the National Health Insurance Scheme (NHIS) has included family planning services in its benefit package, which will also be reflected in CBHI schemes that the NHIS is rolling out in Nigeria.
Some of the factors that were related to altruistic WTP, especially their direction of influence were expected a priori. Most of them are related to income, knowledge or past experiences effects. The higher SES quintile groups and people involved in big businesses were more willing to pay for altruism than others, which could be seen as purely an income effect, coupled with a feeling of community support by higher SES groups. A previous study showed that income was positively associated with altruism that is the higher one earns the more likely to contribute to altruism [
15].
It was also interesting to find that increasing level of education led to increased level of altruism for contraceptives. This could be related to education contributing to increasing level of awareness of usefulness of contraceptives and the need to protect everybody especially the most-poor from unwanted pregnancies. Therefore as educational status increases, improved awareness of benefits of increased universal access to modern contraceptives increases. This finding implies that increasing educational level of people and hence their awareness about the benefits of modern contraceptives, will increase altruism and community solidarity and lead to increased coverage with modern contraceptives, especially within current efforts to identify alternative funding sources for distribution and operational costs. A previous study showed that educational attainment was significantly associated with altruistic behavior [
9].
Also, the finding that age has a negative impact on altruism could point to the fact that at a younger age people are more likely to be willing to pay for the poor because they are still in the working class age group. Hence, it was valid to find that younger people were more willing to make altruistic contributions as they are also expectedly would have being using modern contraceptives and are more aware of the benefits. This assertion is supported by the finding in this study that people that had previously paid for modern contraceptives were more willing to make altruistic contributions compared to people that had not made such payments.
Geographic location of the respondents affected altruism because the urban dwellers who are more likely to have a higher income than those in the rural areas were willing to contribute less altruistically than those in the rural areas. This is not surprising as the rural areas are expected to show more community solidarity because of their homogenous nature than the urban dwellers that are known to be more contextually heterogeneous. However, the fact thatthe Tobit estimation showed that when other variables are taken into consideration, geographic location was not a significant predictor of altruistic WTP does not really negate the possible geographic effects on altruistic WTP.
The finding that females were more willing to make altruistic contributions compared to men is tempered by the fact that most of the respondents were females, hence limiting the direct comparability of altruistic WTP of males and females. Nonetheless, the higher WTP of females could be related to use and perception of personal benefits as most modern contraceptives are intended to protect women from unwanted pregnancies. Hence, although in general, the man is the head of the household and as such is responsible for most charitable giving decisions in the household [
24], this may not be case for modern contraceptives where women possibly attach higher benefits that can accrue to the women in the poorest quintile if they are protected from unwanted pregnancies. Nonetheless, it has been shown that females have been observed to be more prone to altruism when the price of giving is expensive and males are more altruistic when the price of giving is low. But on the same budget, there is no difference [
24].
The finding that the better-off SES were more WTP altruistically is an income effect, because they probably had spare money to spare to help the most-poor compared to the worse-off SES that may not have any money left. Altruism also depends on how important the services are to the targeted population. Those that have been buying modern contraceptives are more prone to altruistic payment for modern contraceptives because they have already used it and have seen the benefits of contraception and are able to decide its level of importance which will influence their decision to pay for others. Hence, the finding that people that had spent some money on contraceptives were more altruistic than others is not surprising.
It was found that lack of money was cited as the major reason for negative altruism amongst some of the respondents. This is related to the income effect already discussed where altruistic WTP increases as SES increases. It was also found that culture and religion did not constrain altruism and this could be attributed to the fact that altruism is seen to be inherent in most humans especially with the concept of kin selection where a person becomes altruistic if ones kin, relations or friends is in need [
25]. Also, it has been argued that cultures of less industrialized societies are most altruistic because the people tend to live in large families and everybody contributes to the welfare of the family [
26].
A study limitation is that a test of criterion validity to determine whether people will actually contribute the altruistic WTP amounts that they stated when asked to do so was not undertaken in the study. However, a previous study in southeast Nigeria showed that there was a strong correlation between stated and actual altruistic WTP for bed-nets [
14]. The scenario for altruistic WTP is not detailed and provided information on how contributions will be collected and managed to the respondents. Also, the study focused mainly on the female sex and so would not be representative of the opinion of the males and thus cannot be generalised to the whole population. It is also possible that potential effects could have limited sample calculation and for data analysis.
This study has generated many areas for future studies. For instance, future research should explore the level that the broader society will be able to make altruistic contributions, instead of just women. Another area of future work will include testing the criterion validity of stated altruistic WTP by determining whether people will actually contribute the amounts of money that they stated and further examining gender and age differences in altruistic WTP. Also, future studies could explore how altruistic contributions would be collected and used as part of community-based health insurance schemes. However, information will be required to decide whether the average cost of collecting altruistic contributions is less than the average WTP, so as to determine whether the collection of such contributions are an efficient means of increasing access to modern contraceptives.
All in all, the finding of positive sense of altruism for provision of modern contraceptives implies that community solidarity should be possibly encouraged by programme managers in reproductive health so the lowest SES quintiles can also benefit from contraceptives. This is especially pertinent as the National Health Insurance Scheme (NHIS) has included family planning services in its benefit package, which will also be reflected in community-based health insurance (CBHI) schemes that the NHIS is rolling out in Nigeria. It will also be useful to involve the whole society in making the altruistic contributions, instead of just women of childbearing age. However, considering that communities are the right holders, their needs for specific family planning methods need to be recognized and the type of contraception included in the benefit package as determined from community consultations on the package of care.