User fees or equity funds in low-income countries

Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal

“…On the basis of these recent data from Kenya, in August 2008, the government of Côte d'Ivoire mandated ART free to all patients [57]. Transportation costs may also play an important role in determining outcomes in those living farther from their site of care [58]–[60]. Studies in Burkina Faso and Mali found decreased viral suppression in patients living farther from the clinic, suggesting follow-up as a major determinant of success [61].…”

Poverty and Access to Health Care in Developing Countries

“…Usually they have occurred as a result of the scarcity of public financing, the prominence of the public system in the supply of essential health care, the government's inability to allocate adequate financing to its health system, the low salaries of health workers, the limited public control over pricing practices by public providers, and the lack of key medical supplies such as drugs. Several international nongovernmental organizations (NGOs) and Western governments are calling for the abolition of user fees for health care, 42–44 whereas other organizations, such as the World Bank, have recently avoided taking a “blanket policy” against them in the absence of compelling arguments for a given country, particularly because governments in many developing countries continue to use them 45,46 . Early user fee studies found that income, price, and quality were not significant determinants of demand for health services and that individuals had a high willingness and ability to pay for health services, 47,48 though later it became clearer that utilization often does vary by price and cost 49 …”

“…Several international nongovernmental organizations (NGOs) and Western governments are calling for the abolition of user fees for health care, [42][43][44] whereas other organizations, such as the World Bank, have recently avoided taking a "blanket policy" against them in the absence of compelling arguments for a given country, particularly because governments in many developing countries continue to use them. 45,46 Early user fee studies found that income, price, and quality were not significant determinants of demand for health services and that individuals had a high willingness and ability to pay for health services, 47,48 though later it became clearer that utilization often does vary by price and cost. 49 There are now many studies in a wide variety of developing countries that have shown that the introduction of user fees or increases in prices can lead to decreased utilization [50][51][52][53] and that this effect can be larger for the poor.…”

Community-funded integrated care outreach clinics as a capacity building strategy to expand access to health care in remote areas of Uganda

“…Though early policies advocated for user fees as a strategy to improve quality, ration limited resources and discourage informal payment networks, many subsequent studies have demonstrated that user fees decrease health service utilization and negatively impact a wide range of outcomes ranging from health to household solvency to gender equality [ 15–19 ]. This has amplified a global movement for universal healthcare as a human right [ 20 ] – regardless of ability to pay – and has also put pressure on donor organizations, governments, and service providers to set policies requiring that health-care services are provided free-of-charge [ 16 , 17 , 21 ]. In the case of Uganda, user fees at public health facilities were abolished in March 2001, leading to increased utilization of health services [ 16 ].…”