Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria

Purpose: Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs.Methods: In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined.Results: Among 80 participants (38% women), most (n=73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2-31.1). Approximately half of the participants (n=41) were willing to pay US$18.5 (78% men), one-third (n=26) were willing to pay US$25.2 (77% men); and 11% (n=9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n=20) would need to sell possessions to raise the funds.Conclusion: Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowedmost of whom were womenwere willing to pay least. Further financial support is required for cataract surgery to be universally accessible.