• Uganda's experience

Uganda's experience with abolishing user fees.

This paper, published in the Bulletin of the World Health Organization (WHO), examines the effects of ending cost sharing (user fees) for outpatient services in Uganda, and how this was perceived by health workers and members of a health unit management committee. With the end of cost sharing, the number of patient visits increased by 53 per cent, although the increase was smaller for children than for adults. Attendances for immunisations, antenatal clinics, and family planning all increased, despite these services having always been free. Perceived quality of services did not seem to suffer, and drugs and medical supplies were perceived to be generally available. However, health workers reported a decline in morale, and many health unit management committees no longer met regularly.

The paper notes that the loss of the discretionary funds raised through cost sharing may be seen by policy makers as a reasonable trade-off for increased access. However, it suggests that the consequences – loss of some autonomy by the health facility and diminished community governance of health facilities – may have long term negative effects. It concludes by arguing that it would be better to have both responsibility to communities and improved access.

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