In its 2008 annual report, the World Health Organization (WHO) urged countries to " resist the temptation to rely on user fees " [1, p. 26]. Indeed, the consensus in the scientific community is that user fees have harmful effects on health care use and household budgets, especially for the poorest [2]. Still, as the WHO observes, " …most of the world's health-care systems continue to rely on th...

About 20 years after initial calls for the introduction of user fees in health systems in sub-Saharan Africa, a growing coalition is advocating for their removal. Several African countries have abolished user fees for health care for some or all of their citizens. However, fee-for-service health care delivery remains a primary health care funding model in many countries in sub-Saharan Africa. A...