Is equity being sacrificed? Willingness and ability to pay for schistosomiasis control in China

Decentralization of the health care system in China has led to an increasin g need for income generation at all operational levels, both for curative s ervices and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-se eking behaviour has yet to be assessed. Public health programmes present pa rticular problems in terms of revenue generation, however, because of the l ess direct impact of these activities on individual health and well-being. In this paper, we report the results of a cross-sectional study of willingn ess and ability to pay for schistosomiasis control. Questionnaires were adm inistered to household heads of six representative villages in the Dongting Lake Region of Hunan Province, China. A total of 628 valid questionnaires were analyzed. The yearly mean household expenditure on schistosomiasis dia gnosis and treatment was RMB 59.50 +/- 146.04 Yuan (US$1 = 8 RMB Yuan), acc ounting for 0.94% of the total yearly household income. Most household head s (514, 82%) thought schistosomiasis was the greatest health threat in thei r communities, but only 30.9% of them were willing to pay for screening, di agnosis and treatment of the infection. On the other hand, 72.3% of the res pondents were willing to undertake volunteer work for control.