Conclusion

There is some degree of consensus about the impacts of user fees. Most studies have found that they have a negative impact on equity, although with some variation regarding the size of this impact. Authors have also disagreed on whether the fees have positive effects on quality of care, and on whether these could outweigh the effects on equity.

Moreover, much controversy remains on what to do about user fees. But whether they are kept or abolished, it is clear that they need to be seen within the context of health care financing more broadly – particularly the introduction of risk sharing mechanisms such as social health insurance; increasing revenue flows from other sources; and ensuring that resources reach the local health centre level.