Impact on child mortality of removing user fees: simulation model.

OBJECTIVE To estimate how many child deaths might be prevented if user fees were removed in 20 African countries DESIGN Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services. RESULTS Elimination of user fees could prevent approximately 233,000 (estimate range 153,000-305,000) deaths annually in children aged under 5 in 20 African countries. CONCLUSION Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.