Responding to budget shortages, many developing nations around the world have adopted formal or informal systems of user fees for health care in public hospitals and health centers. In most countries user fee proceeds represent a small share of total public health facility recurrent costs, but they tend to account for a significant proportion of the resources required to pay for non-personnel c...

OBJECTIVE To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. METHODS Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we use...

BACKGROUND Performance-based financing (PBF) is an increasingly adopted strategy in low- and middle-income countries. PBF pilot projects started in Burundi in 2006, at the same time when a national policy removed user fees for pregnant women and children below 5 years old. METHODS PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health in...

This paper uses Uganda National Household Survey (UNHS) data to investigate, via a discrete choice model, the main determinants associated with seeking private, government and pharmacy based health care, for both adults and children. More specifically, and particularly important given that almost 40% of the Ugandan population are below the poverty line and that policies on user fees have recent...

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF,...