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Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: A study in Tanzania


  • Geneau, Robert
  • Massae, Patrick
  • Courtright, Paul
  • Lewallen, Susan


Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70--in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.

Suggested Citation

  • Geneau, Robert & Massae, Patrick & Courtright, Paul & Lewallen, Susan, 2008. "Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: A study in Tanzania," Social Science & Medicine, Elsevier, vol. 66(3), pages 558-568, February.
  • Handle: RePEc:eee:socmed:v:66:y:2008:i:3:p:558-568

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    References listed on IDEAS

    1. Mariko, Mamadou, 2003. "Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components," Social Science & Medicine, Elsevier, vol. 56(6), pages 1183-1196, March.
    2. Richard D. Smith, 2007. "The relationship between reliability and size of willingness-to-pay values: a qualitative insight," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 211-216.
    3. Johannesson, Magnus, 1996. "A note on the relationship between ex ante and expected willingness to pay for health care," Social Science & Medicine, Elsevier, vol. 42(3), pages 305-311, February.
    4. Borghi, Josephine & Shrestha, Daya L. & Shrestha, Deepa & Jan, Stephen, 2007. "Using focus groups to develop contingent valuation scenarios--A case study of women's groups in rural Nepal," Social Science & Medicine, Elsevier, vol. 64(3), pages 531-542, February.
    5. Richard Cookson, 2003. "Willingness to pay methods in health care: a sceptical view," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 891-894.
    6. Geissler, P. W. & Nokes, K. & Prince, R. J. & Achieng' Odhiambo, R. & Aagaard-Hansen, J. & Ouma, J. H., 2000. "Children and medicines: self-treatment of common illnesses among Luo schoolchildren in western Kenya," Social Science & Medicine, Elsevier, vol. 50(12), pages 1771-1783, June.
    7. Alan Diener & Bernie O'Brien & Amiram Gafni, 1998. "Health care contingent valuation studies: a review and classification of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 313-326.
    8. Richardson, Jeff & McKie, John, 2005. "Empiricism, ethics and orthodox economic theory: what is the appropriate basis for decision-making in the health sector?," Social Science & Medicine, Elsevier, vol. 60(2), pages 265-275, January.
    9. Courtright, Paul, 1995. "Eye care knowledge and practices among Malawian traditional healers and the development of collaborative blindness prevention programmes," Social Science & Medicine, Elsevier, vol. 41(11), pages 1569-1575, December.
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    1. Probst, Lorenz & Houedjofonon, Elysée & Ayerakwa, Hayford Mensah & Haas, Rainer, 2012. "Will they buy it? The potential for marketing organic vegetables in the food vending sector to strengthen vegetable safety: A choice experiment study in three West African cities," Food Policy, Elsevier, vol. 37(3), pages 296-308.


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