• Goal 6: quality

Goal 6: quality

This paper, published in the Journal of Health and Population in Developing Countries, examines the effects of charging fees for health care in 30 health centres in Kabarole District, Uganda, drawing on interviews with health care workers and the general public. Most health professionals supported cost-sharing and felt that the fees were affordable, improved staff morale, lowered waiting times, and increased health staff availability. Members of local communities also felt that cost-sharing should remain. Participants in areas where cost-sharing had been established longer were more likely to report that health services had improved. However, the participants also felt that the poor should receive free treatment.

The paper concludes that people were willing to participate in cost-sharing schemes because they recognised the severe resource constraints affecting the health system and the inability of the government to provide more resources. It argues that the success of cost-recovery depends on the resulting quality improvement of services, which must be sufficient in the view of clients to attract the population to health units on a fee-for-service basis. In Kabarole District, this was made easier by initial donor funding. The paper also emphasises the importance of funds from cost-sharing being kept at the local level, and local communities deciding how to spend them.

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