[stop-imf] UK Comm'n on Africa Calls for Elimination of Healthcare User Fees

[robert weissman]

Commission for Africa
March 11, 2005
http://www.commissionforafrica.org/english/report/introduction.html

Chapter Six
54 Recommendation: Where African governments remove fees for basic
healthcare as part of reform, donors should make a long-term commitment
to fill the financing gap until countries can take on these costs. Many
governments in Africa have sought to develop collective insurance
schemes for health, to reduce the financial burden on the state. Getting
the institutional arrangements for these so that they are equitable has
proved very challenging. User fees have been another approach to sharing
costs. Ensuring the waiver of fees for the poorest has proved
unsuccessful. To reduce the disease burden in the long run, it is
important to reach the entire population. This Commission therefore
recommends that governments abolish user fees. Removing the fees paid by
patients in Uganda increased clinic use by 120 per cent and reduced
health expenditure for the poorest quintile by 13 per cent, who also
captured 50 per cent of the benefit 104. In addition, through the
massive numbers taking up services, a momentum for change and reform is
developed 105. But in order for it to be possible for African
governments to do so, donors will have to guarantee long-term and
predictable compensatory funding until a country is able to take on
these additional costs themselves. The removal of user fees in health
would cost US$8.9 million in Zambia, US$32.8 million in Kenya and
US$31.3 million in Tanzania. This would cover the existing service.
However, with no user fees, demand would also increase and the health
system would need more resources, especially for direct transfers to
clinics.