title: Podoconiosis patients' willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery.
abstract: BACKGROUND
  Podoconiosis 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, Debre Markos University, P,O, Box 269, Debre Markos, Ethiopia. abrish80@gmail.com.
authors.forename: Abreham
authors.initials: A
authors.lastname: Tamiru
authors.forename: Girmay
authors.initials: G
authors.lastname: Tsegay
authors.forename: Moges
authors.initials: M
authors.lastname: Wubie
authors.forename: Molla
authors.initials: M
authors.lastname: Gedefaw
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.forename: Fasil
authors.initials: F
authors.lastname: Tekola-Ayele
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004604:Elephantiasis / Q000191:economics* / Q000628:therapy; D005002:Ethiopia; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006296:Health Services / Q000191:economics*; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012775:Shoes