User fees, global health initiatives, and the Millennium Development Goals
User fees have several important implications for the Millennium Development Goals (MDGs):
- their effects on both health and economic status could mean that they act as a barrier to poor individuals remaining healthy, becoming more educated, or eating – especially where ill health leads to catastrophic costs – preventing the human development MDGs from being achieved
- ill people have lower productivity and so generate less income and are more likely to stay poor
- treatment for children, women, and people suffering priority diseases may be delayed or not happen at all
- payment for drugs will mean that fewer are consumed than is necessary, especially for more expensive drugs (such as drugs for malaria, HIV and AIDS)
The case is being made increasingly that health-related development targets such as the MDGs, will not be met without a drastic increase in the resources flowing to health, as well as adapted health financing policies in order to reduce financial barriers to health services. (See the MDG page on the UN website).
A growing number of global health initiatives, such as the Global Fund for AIDS, TB and Malaria (GFATM) aim to raise the resources flowing for the control of a range of diseases. World Bank grants and loans have also targeted priority diseases such as malaria and AIDS. However, to ensure that these increased resources on the supply side of the health sector are actually used for preventing and treating disease, especially in vulnerable or poor populations, they need to be balanced by initiatives to overcome barriers on the demand side.
The next section of this guide presents evidence that user fees have acted as a barrier to people using health services. Combined with poorly functioning waiver and exemption mechanisms, they have reduced access for the target groups of the health MDGs: children, pregnant women and persons with communicable diseases. On these grounds, meeting the MDGs has been presented as a reason for abolishing fees by advocacy organisations.
