Willingness to pay for cataract surgery in post-operative cataract patients in rural Malawi

In order to improve the sustainability of eye care programs including provision of surgical services, an understanding of a patient's capacity to contribute towards the costs relating to sight-restoring surgery is essential. Therefore, we investigated willingness to pay for cataract surgery in a hospital-based cross-sectional study in rural Malawi.

We interviewed consecutive patients following surgery for senile cataract at Nkhoma Eye Hospital, Malawi. Patients were asked about their willingness to pay for surgery (in local currency, Kwacha, as well as surrogates for money). We also collected data on socio-demographic variables and pre- and post-operative visual acuity (VA).

A total of 212 participants were included (99.5% acceptance), of whom 82.0% were farmers. Mean age of participants was 68.2 years, and 89 (42.0%) were female. There were 136 (64.2%) who were willing to pay something. Median willingness to pay was 500 Kwacha (interquartile range 0-2,000; ~US$3.00, August 2011). Following adjustment for age, sex, family size and occupation, patients who were blind pre-operatively (pinhole-corrected VA<3/60) were less likely to pay something for surgery (odds ratio 0.44, 95% confidence interval 0.20-0.96, P = 0.038) compared to those with VA>6/60.

In this setting where people are used to free services, the median monetary amount elderly patients were willing to pay for surgery is well below the actual cost of screening, transport, accommodation and surgery. Substantial cost recovery will require pre-operative involvement of family members, but might slow down current screening practices and also lower acceptance rates.