An Approach for determining the ability and willingness of communities to finance the control of onchocerciasis using ivermectin in Nigeria

The sustainability of endemic disease control activities is a problem in Nigeria, like in most developing countries due to the budgetary constraints of government and declining foreign AID from donors. Therefore, alternative financing sources are needed, and a virgin source is community financing. However, issues regarding the ability and willingness of communities must be addressed before community financing is introduced. In this vein, a novel, simple, but comprehensive and practical methodology for reliably measuring these two attributes in community financing the control of onchocerciasis using ivermectin was designed. The measures designed are: (1) Willingness to finance (WTF), which can be seen as a multi-dimensional index of consumer choice, and it was derived from the utility function; and (2) Ability to finance (ATF), which is a multi-dimensional index of the ability of the consumers and it was derived from the budgetary constraints of the utility function. The conventional willingness to pay (WTP) techniques were integrated into the approach. A decision-making criteria using various values of ATF and WTF values, as well as the study tools needed for the methodology were designed. Additionally, a system of using a screen methodology for the valuation was illustrated. The approach also included the design of a model community financing scheme based on a pre-payment mechanism, and incorporating community self-distribution of ivermectin. Simulation modelling was used to test the quantitative model of the approach, and results accorded well with all the set hypotheses. In as much as this approach was designed with onchocerciasis control with ivermectin as the focus, it can however be modified and used in other types of endemic disease control. This is especially if community financing is being considered. It can also be used as a rapid assessment technique in order to value consumer choice and issues about ability to support disease control programs or projects. Finally, though this study has its limitations, its strength lies in its possible practical uses as an operational tool.