User fees
Charting the path to the World Bank's "no blanket policy on user fees"
Changes in World Bank policy on fees for health and education: business as usual?
Authors:
G. Hutton
Publisher:
Department for International Development Health Systems Resource Centre , 2004
This paper, published by the DFID Health Systems Resource Centre (HSRC), describes the rise of user fees as a means of financing health, education, and other public services during the 1980. It then examines their impact and considers recent developments. User fees usually contributed a small proportion of overall funding, but their impact on service provision was important because they provided the cash needed for essential items such as drugs. However, the evidence suggests that the fees raised less revenue than expected, discouraged poorer groups from using services, and did not lead to the degree of community participation that was hoped for.
Examining the World Bank’s recent “no blanket policy” on user fees, which advocates basing the decision to charge fees on local circumstances, the paper argues that in many cases this will mean business as usual. Nevertheless, in some countries, user fees have been eliminated on primary education and basic health services. Service utilisation increased enormously, showing a huge unmet demand for these services. The paper argues that the lost revenues from user fees could be picked up by a combined effort of donors and ministries of finance, but that long term vision is needed to do this successfully.
