Podoconiosis patients’ willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery

Abstract

BackgroundPodoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia.MethodsA cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire.ResultsThe majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP.ConclusionsThe considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government’s primary health care system.

The feasibility of eliminating podoconiosis

“…In a small study in northern Ethiopia, over a third of people were willing to pay at least half of the cost of care and over 30% were willing to pay the full cost of shoes. 36 …”

Willingness to pay for footwear, and associated factors related to podoconiosis in northern Ethiopia

“…In Northern Ethiopia use of footwear by the rural community is limited, and non-governmental organizations like International Orthodox Christian Charities (IOCC) provide footwear for school children as a means of preventing podoconiosis. 10 , 11 Given the widespread practice of walking barefoot, addressing the need for footwear is challenging. Free distribution of shoes may appear to be an immediate solution, but its sustainability is questionable.…”

“…To have a lasting impact and high coverage, it is important to introduce cost recovery mechanisms. 10 Cost recovery will have potential benefits: first, individuals who have paid some money may utilize footwear better because of a sense of ownership. Second, the money collected can be used to distribute more footwear to others in need.…”

“…Half of the study participants (45% of women and 54.5% of men) wore shoes during the interview, and 135 study participants (34.4%; 38.1% of women and 31.8% of men) said that they had never worn shoes. 10 Three-quarters of participants were willing to pay at least 50% of shoe production costs, if other treatment services were provided free of charge. 10 This study was focused on willingness to pay for shoes as part of a treatment package, but this is distinct from willingness to pay for footwear as a means of prevention.…”

“… 10 Three-quarters of participants were willing to pay at least 50% of shoe production costs, if other treatment services were provided free of charge. 10 This study was focused on willingness to pay for shoes as part of a treatment package, but this is distinct from willingness to pay for footwear as a means of prevention. The current study was conducted in a podoconiosis-endemic district to assess the willingness to pay for footwear among people with and without podoconiosis.…”