Abstract:
Objectives To examine how drug shop clients’
expenditures are affected by subsidies for malaria
diagnostic testing and for malaria treatment, and also
to examine how expenditures vary by clients’ malaria
test result and by the number of medications they
purchased.
Design Secondary cross-sectional analysis of survey
responses from a randomised controlled trial.
Setting The study was conducted in twelve private drug
shops in Western Kenya.
Participants We surveyed 836 clients who visited the
drug shops between March 2018 and October 2019 for a
malaria-like illness. This included children >1 year of age if
they were physically present and accompanied by a parent
or legal guardian.
Interventions Subsidies for malaria diagnostic testing
and for malaria treatment (conditional on a positive malaria
test result).
Primary and secondary outcome
measures Expenditures at the drug shop in Kenya
shillings (Ksh).
Results Clients who were randomised to a 50%
subsidy for malaria rapid diagnostic tests (RDTs)
spent approximately Ksh23 less than those who were
randomised to no RDT subsidy (95% CI (−34.6 to −10.7),
p=0.002), which corresponds approximately to the value
of the subsidy (Ksh20). However, clients randomised
to receive free treatment (artemisinin combination
therapies (ACTs)) if they tested positive for malaria had
similar spending levels as those randomised to a 67%
ACT subsidy conditional on a positive test. Expenditures
were also similar by test result, however, those who
tested positive for malaria bought more medications than
those who tested negative for malaria while spending
approximately Ksh15 less per medication (95% CI (−34.7
to 3.6), p=0.102).
Conclusions Our results suggest that subsidies for
diagnostic health products may result in larger household
savings than subsidies on curative health products. A
better understanding of how people adjust their behaviours
and expenditures in response to subsidies could improve
the design and implementation of subsidies for health
products.
