Paying for Health Services in East Africa: A Research Note

The goal of providing universal access to health care based upon the Universal Declaration of Human Rights is a laudable one. In nearly all African countries, ‘demands from international donors for increased efficiency and competition are leading governments to play a smaller role in providing health care’ (Panos Report, 1994, p. 1). This paper explores the different healthcare financing initiatives introduced in three East African countries (Kenya, Tanzania and Uganda) in the early 1990s, and examines how effective these reforms have been in addressing the broader goals of access, equity and efficiency in health care. The social and health implications of such reforms on the lives of citizens of these countries were investigated. Although there is a great deal of support for cost sharing, it must be noted that the very essence of such an approach endangers the principles that formed the basis of these reforms. Cost sharing, in whatever form it takes, is burdensome on people with lower incomes and has disastrous consequences for the delivery and utilization of health services by the poor. Finally, the paper concludes by calling on African governments to identify ‘best practices’ in healthcare financing and to develop programs to overcome the illeffects of such policies on the lives of vulnerable groups in society. Social Theory & Health (2004) 2, 94–105. doi:10.1057/palgrave.sth.8700015