Banana Farm Workers’ Preference of an Access to Health Care and Education: A Conjoint Analysis

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Introduction
Like other laws and regulations, enforcement of the global living wage does not happen without the compulsion from government authorities and partnerships. Ideally, growth must be felt down to the grassroots level and the decent standard of living must be attained down to the bottom income-class level of the society. Becker and Stigler (1974) confirms that the aim of enforcement is to attain that desired degree of compliance with the rule of prescribed behaviour, and the critical reason that deters a society from enforcing "complete" compliance is that enforcement is costly. Furthermore, the minimum wage serves as the wage setting mechanism which addresses the price system that fails to work perfectly in labor market. The mandatory floor wage, for example, is one of the social protection policies clearly stipulated under the Labor Code of the Philippines. Almost half of the country's labor force is theoretically protected by law. Salary and wage workers comprise about 50 percent of the entire Philippine labor force, of which 40 percent are private sector workers and only 10 percent are public servants who are not covered by the minimum wage law (Hirose &Vitasa, 2007). The cooperatives allow farmers to establish a cohesive position which has strengthened their bargaining power with investors. Since cooperatives are regulated and well monitored in the Philippines, and, as formal representatives of a large number of individual farmers, with strong organizational structures, and collective assets, they can uphold living wage for the workers' family members.
Locally, an association of cavendish banana growers in Kapatagan, Digos City which is the Kapatagan Banana Growers Cooperative (KBGC), at the foothills of Mt. Apo, Philippines, has started to feel the pressures brought about by economic development and its associated problems such as increased population, waste, and pollution. The agribusiness partnership with growers in Kapatagan Banana Growers Cooperative (KBGC) has contributed to the creation of formal wage employment. However, the compliance with the minimum wage law for the members and sub-members has been a challenge for the past three years. The challenge has compounded when the concept on global living wage was introduced as one of the important criterions in their market-driven certification standards. According to the Sustainable Agricultural Network (SAN) Standards (2017), "living wage is the remuneration received for a standard of 48 hours workweek by a worker in a particular place sufficient to afford a decent standard of living for the worker in a particular place sufficient to afford a decent standard of living for the worker and her or his family." The elements of a decent standard of living include food, housing, education, health care, water, transport, clothing, other essential needs including provision for emergencies and unexpected events. However, it has been noted that the implementation of this approach is challenging because it is perceived to be complicated in the context of the developing countries like the Philippines (Hirose & Vitasa, 2007). In view of the limited empirical and documented evidence of the identification of needs pertaining to living wage, there is, thus, a need to assess the optimal preference of banana workers' access to health and care education.
Even the government has multiple difficulties associated with designing a system to monitor labor standards (Moran, 2005), such as: Problems with defining the specific obligations of countries needed to comply with a core labor standard; Problems with identifying indicators of compliance or noncompliance with each core labor standard; Problems associated with the sources of information; and How to make appropriate inferences from raw data. This scenario generated the so-called "institutional void". It is a result of the breakdown of markets and governance which creates a gap between sellers and buyers that can be addressed by incurring high transaction costs. Likewise, the agriculture sector, for example, remains of critical significance for rural development and social protection.
Moreover, if the agricultural sector remains to be reliant with the Government, the institutional void will not be resolved. In view of this, this study attempted to address market and institutional failures by providing access to information, know-how & technology, all in order to lower the transaction costs in the production of the final good and be competitive in end markets.
A sustainable business or enterprise shall go beyond compliance. In the same manner, a sustainable business case and a sustainable earning model can be linked most easily when they are supported by a societal trend (Tulder, 2018). In this way, addressing societal problems forms the basis of enterprise strategy which is a real source of inspiration for innovative products and services. Part of the strategy shall take part in the 17 agenda of Sustainable Development Goals (SDG) which was introduced by the United Nations last September 25, 2015.
The specific agenda such as (3) Good health and well-being; and (4) Quality education form part the essential needs for workers and their families. In developing countries like the Philippines, the development goals primarily include the attainment of inclusive growth in tackling the issue of underdevelopment.
The four phases of sustainability (Tulder, 2010), guided KBGC to take a proactive stance in addressing living wage concerns. Figure 1 highlights the 4 phases (inactive, reactive, active, and proactive) which present a combination of two key behavioural dimensions: societal responsiveness and fundamental attitudes to society and societal issues. Theoretically speaking, KBGC is still in the inactive phase wherein societal issues confronting the cooperative are recognized. The mere compliance with management systems (i.e., Rainforest Alliance) because customers require it manifests the position of the KBGC in the active phase. Only when the intrinsic motivation of KBGC is directed towards taking responsibility for sustainability can uphold exploiting the full value of sustainability. By doing so, the lead firms, the cooperative, and the farmers aim to take shared responsibility for solving societal problems, thereby, reaching the proactive phase of sustainability.

Study Participants
The participants of this study are the field workers of the KBGC. These workers represent the voice of the primary stakeholders who raised issues pertaining to environmental, social, and health aspects during industry stakeholders' meeting conducted in Barangay Kapatagan last October 10, 2016 (see Annex 2). This study applies a client-centered approach in identifying and analyzing socially relevant issues and needs. In the aspect of health, for example, providers must provide health services that best suit their clients. They must not assume that they are the experts in health but must consider the preferences and concerns of their clients (Lacuesta, 2003). Hence, the banana farm workers' preference of an access to health care and education confirms to the client-centered approach as a vital component in proactive phase to sustainability.

Sampling Procedures
The conduct of the survey employed simple random sampling wherein every worker from the total population has equal chances of being chosen for the study. The sample size of the study is 259, which was determined based on the population size of the total workforce.

Research Design
This study employed quantitative components of research wherein it applied descriptive and explanatory design. Also, the triangulation method was employed as the data were obtained from workers and the related literature review that may support the research findings.
Through literature review, the researcher collected data and information regarding predetermined factors or attributes pertaining to workers' preference in terms of access to health care and education. This was validated during a Key Informant Interview (KII) to the selected field workers who are: at least 5 years in the cooperative.

Statistical Tool
Conjoint Analysis was used in determining the highly preferable attributes of an access to health care and education. It is a rigorous method of eliciting preferences. It allows estimation of the relative importance of different aspects of care and the total satisfaction that respondents derive from healthcare services (Ryan, McIntosh, Shackley, 1998). In this study, the first step was on designing the stimuli carried out through literature and farm records review. These are supported by some related literatures as summarized in Table 1.    (2016) Consequently, Table 2 presents the four attributes such as Frequency of medical mission, Health awareness topics, Annual school supplies, Annual educational information drives with corresponding two levels.

.5 Materials and Instrument
In this study, there are 4 attributes and for each attribute there are 2 levels. Hence, the full factorial design would have (2 x 2 x 2 x 2) 16 combinations. However, through the aid of computer program, these combinations were further reduced into 12 profiles used for defining a subset of stimuli for evaluation. Ranking of the profiles (1 as the most preferred and 12 as the least preferred) by the respondents was conducted in a massive survey process. Sample profiles are shown in Table 3. Data coming from the conjoint experiment was processed using SPSS 20 (Trial Version). Traditional conjoint analysis was then performed to determine how important the different factors are in the decision making process of the respondents, appraise the utility measures of each factor levels, and simulate which combination of factors yield the best preferences for the workers.

Results
Presented in table 4 is the relative importance rating of all the respondents on the four attributes. The range of the utility values (highest to lowest) for each factor provides a measure of how important the factor was to overall preference. Factors with greater utility ranges play a more significant role than those with smaller ranges (SPSS Conjoint, 2014).
Surprisingly, the attribute with highest utility is Information Drive. This attribute has two levels (Climate Change and Ecosystem Conservation), followed by Frequency of medical mission, school supplies and awareness. The Conjoint Analysis revealed that the information drive has the highest utility value of 27.099. Here, respondents prefer topics on climate change, which simply means that the care for the environment, especially on the topics of carbon footprints reduction and waste management are being taken into consideration. The second variable with the highest utility value is the frequency of medical mission or in which respondents prefer that the medical mission being done in a semi-annual basis. School supplies comes out to be third in rank in terms of utility value, with respondents preferred writing materials and books with a total utility value of 24.271. In this case, farm workers are putting more emphasis on their child's educational materials directly attributable to classroom learning and studying. Moreover, health awareness comes out with the lowest utility value of 22.812. This may imply that farm workers are not taking health awareness as an issue because the topics on AIDS/HIV prevention and Hepatitis or PTB DOTS are not socially relevant in their context.
Presented in table 5 is the specified utility of each level of the four attributes. Higher utility values indicate a greater preference and lower values for lower utility. Respondents highly preferred a health awareness program on hepatitis and PTB DOTS, writing materials and books as educational supplies, climate change as an information drive, and a semi-annual frequency of medical mission.  Table 6 presents the simulation of all the profiles of a health and education programs. Based from the simulation, a highly preferred access to health care and education design has an health awareness session on hepatitis B and PTB DOTS, provision of writing materials and books as educational supplies, information drive on climate change, and a semi-annual medical mission. This design has a total utility of 0.084. The combination with the lowest utility is design with awareness sessions on hepatitis B and PTB DOTS, provision of school uniform and shoes, information drive on ecosystem conservation, and annual medical mission with a total utility of -0.864.  Table 7 displays the result of the reversals. The study specified frequency of medical mission as in linear models. This means that respondents are expected to choose a level where a medical mission is to be conducted annually or semi-annual. However, the reversals show that 45 percent of the respondents preferred an annual medical mission. It is suspected that that these group of farm owners are not merely particular on the issue of frequency of medical mission. Remember that the holdout profiles (four in the present example) were rated by the subjects but not used by the conjoint procedure for estimating utilities. Instead, the conjoint procedure computes correlations between the observed and predicted rank orders for these profiles as a check on the validity of the utilities. In many conjoint analyses, the number of parameters is close to the number of profiles rated, which will artificially inflate the correlation between observed and estimated scores. In these cases, the correlations for the holdout profiles may give a better indication of the fit of the model (SPSS Conjoint, 2005) Based on the "Phase Model of Sustainable Development" ( Van Tulder, 2010), the findings have provided some perspectives on KBGC's transition to sustainability. It highlights the crucial steps involved from the "active" phase (taking responsibility for societal issues by maintaining the Rainforest Alliance certification) to the "proactive" phase (externally oriented and aims to take shared responsibility for solving societal problems). Since the goal in a proactive phase is to involve both primary and secondary stakeholders in sustainability strategy, the identified attributes of the study such as Frequency of medical mission; Health awareness topics; Annual school supplies; and Annual Information drive topics provide an opportunity to demonstrate partnership and collaboration.
Finally, in the banana industry, for example, KBGC can use the findings of the study to engage with different partners to address related risks such as: Labor and working conditions, Environmental risks, Community, Health, and Security Risks. The identified attributes and levels in the study resemble the "list of wants" of KBGC which calls on stakeholders to work with them on solutions to these problems.

Discussion
The result of the Conjoint Analysis revealed that the attributes with the highest relative importance is information drive, followed by frequency of medical mission, provision of school supplies, and conduct of awareness program. Furthermore, the model simulation revealed that the optimal combination that represents the farm workers' preference involves: Health awareness on hepatitis B and PTB DOTS; Provision of school supplies such as books and writing materials; Information drive on climate change; and a semi-annual (every 6 months) medical mission.
Per identified optimal set of preferences, it is suspected that over the years, the farm workers have felt the need to be educated about climate change and workers' health and welfare from the experiences gained in fulfilling the rigorous environmental and social standards set by the certification requirements of Rainforest Alliance (RA).
Hence, apart from gaining leverage on addressing the demands of RA certification requirements, the result of the study presents an opportunity to KBGC on how to transition from its current active phase to the proactive phase of sustainability. The identified attributes (information drive, frequency of medical mission, provision of school supplies and conduct of awareness program) shall not be taken into something that is within the liability concept. Instead, the cooperative shall uphold the value of responsibility to gain a proactive stance in achieving sustainability. Further, similar study and method should be conducted especially to other industries. A Key Informant Interview or Focus Group Discussion shall be employed to come up with a strong and scholarly set of product or services' attributes concerning primary and secondary stakeholders.
Attributes RRL References shift the culture of STEGHs from focusing on trainees and their home institutions to also considering benefits in host communities and nurtur ing partnerships. The authors propose four core principles to guide ethical development of educational STEGHs: (1) skills building in cross-cultural effective ness and cultural humility, (2) bidirectional participatory relationships, (3) local capacity building, and (4) long-term sustainability. 633-638. doi.org./10.1097/ACM.000000000001009 Partnership is the key to improve medical missions. Based on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed. During the 1990s, conjoint analysis was developed to elicit patients' and the community's views on health care. Ryan, M. (2000). Using conjoint analysis to elicit preferences for health care. doi: https://doi.org/10. 1136/bmj.320.7248.1530 This paper adds to an increasing literature on methodological questions addressed in the application of conjoint analysis (CA) in health care. In addition, individual preferences were found to be determined by experiences, which raise potentially important questions regarding the elicitation and use of such preferences in economic evaluation. Ryan, M., McIntosh, E., Shackley, P. (1998). Methodological issues in the application of conjoint analysis in health care. doi.org/10.1002/(SICI)1099-1050(199806)7:4<373::AI D-HEC348>3.0.CO;2-J By using conjoint analysis to analyze new combinations of attributes, we found that respondents would most prefer instant, highly accurate home tests, even though they are not currently available in the U.S. Respondents were willing to pay $39 for a highly accurate, instant home test. Phillips, K.A., Maddala, T., Johnson, F.R. (2002  In a recent study conducted in Digos City, it was noted that the adolescents expressed their need for holistic reproductive health services for the youth in their barangays. They revealed that they were aware of the common issues and concerns being confronted by their peers such as substance abuse (smoking, drinking and drug addiction), pre-marital sex, early marriages, abortion, sexually transmitted infections and others.

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 Pre-marital sex was identified as the third most common problem. They were also aware of the reproductive health services provided by the government health facilities. Some of them have availed of the services of the public facilities but complained about the poor accommodation, presence of "palakasan" or favoritism, and inadequacy of supplies and facilities. T  hus, reproductive health remains a top priority research area, aiming specifically on adolescents and indigenous peoples' health concernsa topic that is seen as seldomresearched, Developing countries spend hundreds of billions of dollars each year on schools, educational materials and teachers, but relatively little is known about how effective these expenditures are at increasing students' years of completed schooling and, more importantly, the skills that they learn while in school. The few variables that do have significant effects -e.g. availability of desks, teacher knowledge of the subjects they teach, and teacher absence -are not particularly surprising and thus provide little guidance for future policies and programs.
A well funded primary school provides textbook and other school supplies inside the classroom and the child will share it with another student. Eisemon, T.O. (1988). Benefiting from basic education, school quality and literacy in Kenya. McGill University, Montreal Canada. Pergamon Comparative and International Education Service. Ensuring the availability of essential inputs. Few schools have the inputs necessary for effective instruction, thus limiting the scope for improvements in classroom processes. In many instances attempts to improve the quality of education falter in the absence of even the most basic instructional materials and supplies. Johnson, D. (2008