• User fees, global health initiatives, and the Millennium Development Goals

User fees, global health initiatives, and the Millennium Development Goals

This paper, published in the British Medical Journal, estimates how many child lives would be saved if user fees for health care were removed in twenty African countries, using evidence from South Africa, Uganda, Madagascar, and Kenya. Its analysis shows that abolition of fees could prevent between 153,000 and 305,000 child deaths annually – between 4 and 8 per cent of the total. Most of these lives would be saved by increased use of simple curative interventions such as antimalarials and antibiotics combating dysentery and pneumonia. Deaths might also be reduced through increased use of preventive services, although this effect would be smaller and not guaranteed.

The paper concludes that abolition of user fees can have an immediate and important effect on reducing child deaths. However, these gains will only be sustainable if policy makers establish viable alternative financing mechanisms which account for the likely increase in demand following removal of the fees. But given that user fees have generated on average only about 5 per cent of recurrent expenditure, the authors argue that the extra money would be small relative to the benefits. They advocate replacing user fees with more equitable financing methods as an effective first step towards improving children’s access to health care services and achieving the Millennium Development Goals for health.

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