The Impacts of User Fees on Health Services in Sub-Saharan African Countries: A Ctirical Analysis of the Evidence

Abstract

The momentum towards achieving the United Nations Millennium Development Goals re-invigorated concerns around sustainable health care financing and the adequacy of the financing arrangements in many lowresource settings. Accordingly, this necessitated the institution of user-fees as part of health financing reform in many countries in sub-Saharan Africa. These fees are charges levied at the point of service with the intent of reducing 'frivolous' consumption of health services, increasing the quality of services available and at the same time increasing coverage and utilisation of services. Likewise, as a 'decisive' policy to cushion the existing challenges facing health care financing in the region, a critical assessment of the assertions of proponents of user fees who use the principle of cost recovery and revenue mobilization to drive the concept of rational utilization, efficiency and equitable distribution of health care services is often exaggerated. As it were, the available evidence suggests that user fees alone will not likely accomplish equity, efficiency, or the sustainability objectives in health services in the region. What is critical is that user fees should be linked to the broader package of financing -such as insurance coverage-and with a view to averting any form of equity danger that may thus arise.

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User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica

“…Such fees have been used to generate revenues for health care providers, reduce health care financing burden on governments and encourage clients to use health services more judiciously [1]. Historically, both the World Bank and the International Monetary Fund (IMF) have promoted user fees [2,3]. Yet evidence points to negative effects on equitable access to health services, and arguably increased households’ health expenditures.…”

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“…In most of these low-middle-income Sub-Saharan African countries, healthcare access is based on a user fee service model. However many are hoping to move to universal health care access [ 4 ]. According to published literature, refugees’ health care needs are complex [ 5 , 6 ] and therefore they require integrated, community-based primary health care interventions in a culturally safe and timely manner [ 7 , 8 ].…”