JAOA • Vol 105 • No 1 • January 2005 • 25-
Is Equity Being Sacrificed? The Effect of User Fees on the Willingness and ability to pay for Schistosomiasis Control in the Lake Victoria Region of Tanzania
Jesse M. Rohde*;
Mathias Abuya
;
Sharon Kunin-Brown*;
Eiman Mahmoud, MD, MPH*
This study asks: In an effort to finance schistosomiasis prevention and
treatment activities, have countries such as Tanzania lost sight of those most
in need? With the new policy of user-fee charges in place, is effective
treatment still a priority for those in heavily endemic regions? The impact of
charges on health-seeking behavior is crucial to disease control in Tanzania.
The decentralization of the country's healthcare system has led to an increase
in the need for income generation at all operational levels. In general,
people have accepted the costs of curative services. However, the impact of
user-fee charges on health-seeking behavior has yet to be assessed. This is a
crosssectional study of willingness and ability to pay for schistosomiasis
control. Questionnaires were administered to household heads of six
representative fishing and farming communities in the Lake Victoria Region of
Tanzania, East Africa. A total of 103 questionnaires were analyzed. The yearly
mean household expenditure on schistosomiasis diagnosis and treatment was
7,000Ts ± 60,000Ts (US$1 = 1,000Ts), accounting for 1.54% of the total
yearly household income. Most household heads (85 [83%]) thought
schistosomiasis was the greatest health threat in their communities, but only
27 (26%) of them were willing to pay for screening, diagnosis, and treatment
of the infection. On the other hand, 72 (70%) were willing to do volunteer
work in exchange for schistosomiasis control. Exposure and livelihood cannot
be separated; the future of disease control in this endemic region of Tanzania
is about access, not prevention.
* Touro Univeristy College of Osteopatthic
Medicine (TUCOM), Vallejo, Calif; Shirati
Community Health Center, Shirati, Tanzania, East Africa
