• Abolition of user fees

Abolition of user fees

This paper explores whether the abolition of user fees in Uganda in March 2001 has led to greater access health facilities for poor people and has reduced the risks of catastrophic health expenditures. Using data from National Household Surveys undertaken in 1997, 2000 and 2003, the paper finds that utilisation of first level government health facilities among the poor increased much more rapidly after the abolition of fees. Unexpectedly, the incidence of catastrophic health expenditure among the poor did not fall. This is likely to be because the frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies.

The paper concludes that the abolition of user fees at public facilities made these services more accessible for both poor and non-poor households, although for the non-poor there is no evidence that the abolition of fees increased demand for services. The elimination of fees can have unintended consequences, particularly where fees were used to replenish pharmaceutical stocks, provide financial incentives for staff, or to upgrade infrastructure. The paper recommends that countries thinking of removing user charges should first examine what types of activities and inputs at the facility level are funded from the revenue collected by fees, and then develop mechanisms to ensure that these activities can be sustained subsequently.

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