The economics of blindness prevention in Upper Volta under the Onchocerciasis Control Program

This paper proposes a new approach to the economics of blindness prevention under the Onchocerciasis Control Program in Upper Volta. It differs from previous economic analyses of onchocerciasis control in three important respects. First, it uses empirical data as the basis of an estimate of the epidemiological effectiveness of the intervention. Second, it focuses on the prevention of permanent disability and premature death due to onchocercal blindness as the major health improvement attributable to onchocerciasis control. Third, it emphasizes cost-effectiveness rather than cost-benefit analysis. This limitation is imposed by the difficulty of undertaking a comprehensive assessment of the benefits of onchocerciasis control. In particular, the extent to which control of partial visual impairment and infection without ocular involvement would increase the effective supply of labor, and also the extent to which control would increase the effective supply of land by inducing new settlement in the river valleys, have not been clearly established. The cost-effectiveness approach is limited because it foregoes the opportunity provided by cost-benefit analysis to compare the relative desirability of investing in onchocerciasis control with alternative investments in other sectors. However, it does permit useful judgments to be made about the relative efficiency of allocating scarce resources to onchocerciasis control compared to other possible investments within the health sector. For this purpose, an illustrative comparison is made with estimates of the cost-effectiveness of measles immunization.