This study asks: In an effort to finance schistosomiasis prevention and treatment activities, have countries such as Tanzania lost sight of those most in need? With the new policy of user-fee charges in place, is effective treatment still a priority for those in heavily endemic regions? The impact of charges on health-seeking behavior is crucial to disease control in Tanzania. The decentralization of the countries health care system has led to an increase in the need for income generation at all operational levels. In general, people have accepted the costs of curative services. However, the impact of user-fee charges on health-seeking behavior has yet to be assessed. This is a cross-sectional study of willingness and ability to pay for schistosomiasis control. Questionnaires were administered to household heads of six representative fishing and farming communities in the Lake Victoria Region of Tanzania, East Africa. A total of 103 questionnaires were analyzed. The yearly mean household expenditure on schistosomiasis diagnosis and treatment was 7,000Ts +/- 60,000Ts (US$1 = 1,000Ts), accounting for 1.54% of the total yearly household income. Most household heads (85, 83%) thought schistosomiasis was the greatest health threat in their communities, but only (27, 26%) of them were willing to pay for screening, diagnosis and treatment of the infection. On the other hand, (72, 70%) were willing to do volunteer work in exchange for schistosomiasis control. Exposure and livelihood cannot be separated; the future of disease control in this endemic region of Tanzania is about access, not prevention.