Household willingness-to-pay for formal residential care for the elderly in an urban setting in Accra, Ghana

Background Long-term, informal care for the elderly in many sub-Saharan African countries is the responsibility of the family. However, urbanization, migration and the gradual nucleation of families is threatening this responsibility. As the burden of long-term care increases, traditional family support may no longer suffice and as such formal systems of care needs to be explored. While formalized care comes at a cost, it is unclear whether households will be willing and able to pay for these services. This study therefore sought to assess households' willingness-to-pay (WTP) for formal residential care for the elderly in an urban setting in Ghana. Methods This was a cross-sectional study, conducted at the La Nkwantanang-Madina Municipality in Accra among 460 households. The study used a mixed sampling design, combining purposive and stratified random sampling techniques. A structured questionnaire was employed to gather data on socio-economic, demographic, health characteristics of the elderly and caregivers. The Contingent Valuation Method (CVM) was used to assess households' WTP for formal residential care for the elderly, while multiple logistic regression was employed to identify factors influencing households' WTP. Results The study showed that about 72% of households indicated their willingness to pay for formal residential care for the elderly, with an average amount of US$122.35 (US$27.3-US$272.7) per month for the holistic service. Age of household head (OR = - 0.034, p = 0.02), household income (OR = 1.60, p < 0.01), employment status of household head (OR = 2.75, p = 0.01), awareness of the existence of the service (OR = 2.07, p < 0.01), belonging to the richer household (OR = 2.56, p < 0.00) and presence of an elderly member in the household (OR = 2.84, p < 0.01) were all significantly associated with households' WTP for formal residential care for the elderly. Conclusion The study revealed a significant proportion of households were willing to pay for formal residential care for the elderly. Factors such as age, income, employment status, presence of elderly and awareness of care options were significantly associated with the households' decision-making processes. This increased interest offers a potential market for provision of formalized elderly care homes services within the capital. Raising awareness and benefits is key in unlocking this service package to the population.