PHA-Exchange> User fees

[claudio at hcmc.netnam.vn]

 from Stuart Cameron <S.Cameron at ids.ac.uk> -----

User fees for health care
-------------------------

We would like to draw attention to the following as relates to some of the 
issues on user fees:

1. User fees for immunisation

There seems to be a consensus against charging user fees for es-
sential vaccinations. The World Bank recommends that immunisa-
tion should be free for all; and the 1997 Addis Ababa consensus
recommended that such services should be either free of charge
or substantially subsidised.

World Bank policy -
http://www.eldis.org/healthsystems/userfees/background.htm#worldbank

Designing better user fee systems -
http://www.eldis.org/healthsystems/userfees/conclusion.htm#design

2. User fees, efficiency and accountability

There is not much support for the idea that user fees improve
efficiency or reduce "frivolous" use of the health system. How-
ever, as part of the Bamako Initiative they do seem to have
helped support decentralisation and community management.

Experiences with user fees -
http://www.eldis.org/healthsystems/userfees/experience.htm

3. Abolishing user fees: where will the money come from?

When Uganda abolished user fees it replaced the lost income by
broadening the tax base, increasing health budgets, and through
extra donor funding. A role for donor support was recognised by
G8 leaders at the 2005 Gleneagles summit, who pledged support
for African governments which chose to provide free health ser-
vices.

But it has been argued that African governments should be cau-
tious about relying on donor funding because it can be unreli-
able. One step that they could consider taking is to increase
health spending to 15 per cent of total budgets, in line with
the 2001 Abuja declaration.

How to abolish user fees -
http://www.eldis.org/healthsystems/userfees/conclusion.htm#howto

Uganda's experience with abolishing fees -
http://www.eldis.org/healthsystems/userfees/experience.htm#uganda


--
Stuart Cameron
Institute of Development Studies, UK



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