BACKGROUND Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub...

The introduction of cost-sharing strategies such as user-fees for health care in developing countries has received increasing attention due to declining government expenditure on health and reduced donor funding. Many governments of developing countries face the dilemma of introducing fees for family planning services while maintaining contraceptive prevalence rates. This study conducted 16 foc...

This article analyzes the historical background of the institutionalization of user fees and their subsequent abolition in West Africa. Based on a narrative review, we present the context that frames the different articles in this supplement. We first show that a general consensus has emerged internationally against user fees, which were imposed widely in Africa in the 1980s and 1990s; at that ...

Since the 1980s, most developing countries have adopted a policy of user fees for health care services. Such policies, however, reduce access to services for those unable to pay. A variety of options have been explored to mitigate this negative effect, and these are the subject of three policy briefs that complement this one. One option is to eliminate this type of policy by abolishing health s...

A-portion of the 1995 National Survey on Recreation and the Environment examined public opinion toward user fees as a means of funding recreation services on public lands, including campgrounds, boat ramps, trails, picnic areas, historic sites, restrooms, parking areas, special exhibi ts SC presentat ions, visi tor centers, and other facil i t ies. Respondents were offered five choices to fund ...

— Using a nested multinomial logit model, this study investigates the demand ‘‘reduction’’ and ‘‘diversion’’ effects of user fees in rural areas of Ethiopia. The results reveal that an increase in user fees of public clinics, which are the most widely used alternative, can have a significant demand reduction effect on the poorest of the poor. This implies that despite cost recovery has been adv...

BACKGROUND It has been argued that quality improvements that result from user charges reduce their negative impact on utilization especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1st March 2001. This gave us the opportunity to ...

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-...

Tough economic times stir up anxiety over the affordability of public services—especially healthcare. As governments struggle to balance budgets, and healthcare spending continues to grow faster than the economy, conditions are ripe for old—and often discredited—policy ideas to make a comeback. User fees are no exception. At first blush, user fees appear to be an obvious solution. After all, an...