Public health systems in most low-income countries are unfair to poor people. Clearly preventive and curative public health-care services, especially hospital services, are accessed by poor people less frequently than by those who are better off . This injustice is now high on the international agenda. A solution for this issue has some global dimensions, such as the need for a large transfer o...

OBJECTIVES Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. SETTING Women's experience of user fees in 5 African co...

Following an electoral dispute, the central highlands of the island of Madagascar were subjected to an economic blockade during the first half of 2002. After the blockade ended in June 2002, user fees for health services and school fees were progressively eliminated. This paper examines the provision of schooling and health services to rural areas of Madagascar before, during, and after the blo...

The next iterations of the Generic Drug User Fee Act and the Biosimilar User Fee Act are meant to encourage new generic and biosimilar products, but higher fees and budget reductions may threaten progress.

In Africa, user fees constitute a financial barrier to access to health services. Increasingly, international aid agencies are supporting countries that abolish such fees. However, African decision-makers want to know if eliminating payment for services is effective and how it can be implemented. For this reason, given the increase in experiences and the repeated requests from decision-makers f...