Health financing is part of an action research project that aims to eliminate malaria (MEPR project) in the community of Ruhuha in southern east Rwanda. The main thrust of the project is local community involvement and (co-)financing of interventions that can tackle malaria. A study component has recently established that rice farming in the area creates significant malaria risk, which is in line with earlier work that documents this link between rice cultivation and malaria in various settings. So far, none of the interventions that have been proven to be effective in tackling rice farming-induced mosquito breeding sites have been implemented in Ruhuha. Therefore, the project has decided to use external funds to support a larviciding intervention with Bacillus thuringiensis israelensis (Bti) (Figure 1), but for just one rice cultivation season (semester). Future interventions will thus depend on co-payment of rice farmers and the wider community. The present research project, conducted prior to Bti application, aims to assess the willingness to pay (WTP) for larviciding.

In a recent study survey, out of 1,914 rice farmers organized into four cooperatives, 320 farmers were randomly selected to participate in a cross-sectional study conducted in January 2015. The maximum willingness to pay was elicitated through a contingent valuation exercise using the ”bidding game method”. In eliciting their WTP, participants were presented with two different financing schemes; a lumpsum deduction, whereby all farmers contribute the same amount; and a progressive deduction, where contribution levels are linked to land size. In addition to this hypothetical valuation experiment, focus group discussions were held to obtain a wider sense of acceptability of the intervention on the part of the rice farmers.

All participants accepted that Bti be applied in their fields. The mean WTP was FRW 1,544 (US$ 2.2) and FRW 329 (US$ 0.5) per farmer per season for lumpsum and progressive deduction (per acre), respectively. The median WTP revealed that 50% of the participants were willing to pay at least FRW 1,000 (US$ 1.4) and 200 (US$ 0.3) for lumpsum deduction and per acre, respectively. A multivariate analysis showed that more income from rice, a higher starting bid, being cued first on a lumpsum rather than a progressive deduction, having experienced malaria episode over the last year, higher starting individual share capital in cooperative, bigger land size, rice farming as the most generating income crop and positive trend of income from rice over the last three years, were significantly associated with higher WTP (p<0.05).

While acceptability of the intervention appears generally high, as witnessed for instance by a stated willingness to invest (non-compensated) labor time in applying Bti once it is established that it is effective in reducing malaria incidence, the WTP levels reported can only cover one fourth (1/4) of the full intervention cost (FRW 6,355 or US$ 9 for lumpsum and FRW 1,308 or US $ 1,8 per are). To fill this gap, financing models need to be developed to support rice farmers and their communities to increase the sustainability of the intervention.