Did primary healthcare user fee abolition matter? Reconsidering South Africa's experience

Building on the user - fee experience : The African case DISCUSSION

The lessons of user fee experience in Africa.

This paper reviews the experience of implementing user fees in Africa. It describes the two main approaches to implementing user fees that have been applied in African countries, the standard and the Bamako Initiative models, and their common objectives. It summarizes the evidence concerning the impact of fees on equity, efficiency and system sustainability (as opposed to financial sustainabili...

School Fee Abolition: Impact on Learning and Persistence

Introduction It is an undisputed fact that the abolition of primary school fees has led to vast enrollment gains in several countries. After fees were abolished in Malawi in 1994 and in Uganda in 1997, enrollment in both countries grew by 68 percent (Avenstrup, Liang & Nellemann, 2004). Lesotho’s graduated abolition of fees, beginning in 2000, led to a Grade 1 enrollment increase of 75 percent,...

A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition

BACKGROUND To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikin...

Can South Africa Afford to Become Africas First Welfare State?

This paper assesses the economy-wide impact of implementing and financing a universal or basic income grant (BIG) in South Africa. The various financing scenarios suggested by the proponents of the grant are presented, and these are compared using an applied general equilibrium model for the South African economy. The results indicate that the required changes in direct and indirect tax rates n...