Willingness to pay for cataract surgery in two regions of Tanzania

Background: Knowing what rural populations are willing to pay for cataract surgery is essential if improvements in cost recovery in eye care service provision programmes are to take place. The authors sought to learn about willingness to pay for cataract surgery in two separate regions of Tanzania. Methods: Patients desiring cataract surgery were interviewed in Kilimanjaro Region and Iringa Region of Tanzania to learn how much they and their families were willing to pay for surgery and how "wealthy" ( using ownership of several household objects as a proxy for wealth) the household was. Results: 60 cataract patients in Kilimanjaro and 49 in Iringa were interviewed. "Wealth" was significantly associated with willingness to pay in each region. The average expressed willingness to pay was 2457 Tsh ( SD 4534) or approximately $ US 2.30, which is far below the actual cost of providing the service. Conclusion: There were significant differences in the expressed willingness to pay between Iringa and Kilimanjaro patients, which may reflect differences in the services provided in the regions. Willingness to pay may increase as the population gains familiarity and trust in the service. It may also be increased by ensuring that pricing is uniform and clearly advertised throughout regions and by educating health workers and counselling patients about the real costs of providing high quality surgery. Offering "free" services to all may result in lower expressed willingness to pay.