Abolishing user fees in Africa? It depends ....

Mark Pearson, December 2005

International experience suggests that the case for reducing or removing official user fees for primary health services is strong. This is based on evidence that fees raise little money and tend to be an inequitable and inefficient means of funding health care.

However, recent assessments suggest that focusing on user fees alone addresses the symptoms and not the causes of poor performance at primary care level. This paper sets out the wider issues involved in light of the impact of the new cost sharing policy introduced in Kenya in mid-2004 and experiences elsewhere – notably Uganda.