Goal 6: quality
User fees in government health units in Uganda: implementation, impact, and scope
Health user fees in Uganda: health workers like them, patients don’t
Authors:
J.K. Konde-Lule; D. Okello
Publisher:
Partners for Health Reformplus , 1998
This paper, produced by Partners for Health Reform Plus, investigates patients’ and health workers’ views on user fees for government health services in Uganda. It finds that, despite an unclear government position on cost sharing, user fees were levied at all the government health units studied. Health workers accepted the fees and reported that they had improved morale. Patients disliked them and were less likely than health workers to acknowledge positive outcomes such as improved supplies of drugs. Patients and communities generally had little knowledge about the operational details of cost sharing or health unit management committees. Health workers withheld information which they feared could lead to less money being collected, such as the exemption criteria for people who cannot afford to pay user fees.
The paper concludes that implementation of cost sharing has been problematic largely because of unclear policies and corruption in the health units. Whilst the fees have had some positive impact on the quality of health care, a low level of community awareness has created negative feelings towards them. The authors advocate more public participation in decisions related to user fees, and argue that with increased transparency and less corruption, they could play a larger and more positive role in the future.
