Uganda's experience with abolishing user fees.
An unnecessary evil?: user fees for healthcare in low-income countries
User fee removal must be accompanied by long-term donor support
Authors:
S. Witter
Publisher:
Save the Children Fund , 2005
This paper, from Save the Children, examines user fees, their impact on health services and households, and the consequences of removing them. Findings show that user fees have been an inadequate form of health care financing, representing less than 10 per cent of the health care budget, and are expensive to collect. The paper also finds that user fees: do not ensure equal access to health services; have not improved the quality or coverage of health services; and have reduced the overall use of health services by the poor and vulnerable. However, despite their inefficiency, many donors continue to support them because they see no alternative and believe that private payments may help to ‘empower’ patients.
The document reviews the experience of various countries in removing user fees from their health services, such as South Africa, Uganda and Madagascar. Findings reveal that the abolition of user fees can produce significant equity, efficiency and political gains. However, not all health systems will be able to remove fees immediately. Other reforms will be needed, and donors need to provide long-term financial and technical support to allow for this policy change. [adapted from author]
