Freeing-up Healthcare: A guide to removing user fees

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Health systems reforms in Uganda: processes and outputs

The book provides an analytical review of the implementation of Uganda's health sector plan for the period 2000 - 2005 and generates policy and programme implications for improving the current 5-year plan ((2005 - 2010)

Gender analysis of health facility utilization in Uganda

A gender analysis study of health facility utilization rates in Uganda over the period July 2003 to April 2004 was undertaken in four districts of Uganda. The key conclusions are that: (1) Collecting data to analyze for gender and age categories is a possible but tedious in a paper based system and is made more difficult in the absence of the Records Assistants; (2) Despite the limitations of sample size, there are indications that gender and age specific inequities do exist; (3) Although the study makes no firm conclusions as to whether there is gender or age specific inequity in OPD attendance, it does indicate that this information is collected using the current HMIS;(4) In an attempt to provide technical support to ensure that such data will be subsequently easy to retrieve, the team worked with the RA and I/C during the review but the contact was limited and it cannot be guaranteed that the process of data retrieval was improved. The key recommendations are that: (1) Conduct a detailed gender analysis study for the HSSP output indicators such as OPD utilization, immunization rates and some priority diseases such as malaria, and ARI pneumonia especially in childhood. (2) Institutionalize the conduct of gender and age specific analysis of routine HMIS data. A more pragmatic approach would be to conduct such record reviews every year or to routinely report gender disaggregated data in the HMIS monthly report. (3) Improve the capacity for HMIS data management to ease retrieval and analysis at facility level

Poverty and user fees for public health care in low-income countries; lessons from Uganda and Cambodia [viewpoint]

Public health systems in most low-income countries are unfair to poor people. Clearly preventive and curative public health-care services, especially hospital services, are accessed by poor people less frequently than by those who are better off.1,2 This injustice is now high on the international agenda. A solution for this issue has some global dimensions, such as the need for a large transfer of resources from high-income to low-income countries.3 Yet, in terms of the best use of these supplementary resources, defi nite solutions should be developed in every country. National policy makers have strategic choices to make in their eff orts to reach poor people.4 One option that policy makers might consider is the removal of the fees charged to users by public health facilities. A key strategy in the 1980s was user fees,5 whic

Abolition of user fees: the Uganda paradox

Inadequate health financing is one of the major challenges health systems in low-income countries currently face. Health financing reforms are being implemented with an increasing interest in policies that abolish user fees. Data from three nationally representative surveys conducted in Uganda in 1999/2000, 2002/03 and 2005/06 were used to investigate the impact of user fee abolition on the attainment of universal coverage objectives. An increase in illness reporting was noted over the three surveys, especially among the poorer quintiles. An increase in utilization was registered in the period immediately following the abolition of user fees and was most pronounced in the poorest quintile. Overall, there was an increase in utilization in both public and private health care delivery sectors, but only at clinic and health centre level, not at hospitals. Our study shows important changes in health-care-seeking behaviour. In 2002/03, the poorest population quintile started using government health centres more often than private clinics whereas in 1999/2000 private clinics were the main source of health care. The richest quintile has increasingly used private clinics. Overall, it appears that the private sector remains a significant source of health care. Following abolition of user fees, we note an increase in the use of lower levels of care with subsequent reductions in use of hospitals. Total annual average expenditures on health per household remained fairly stable between the 1999/2000 and 2002/03 surveys. There was, however, an increase of US$21 in expenditure between the 2002/03 and 2005/06 surveys. Abolition of user fees improved access to health services and efficiency in utilization. On the negative side is the fact that financial protection is yet to be achieved. Out-of-pocket expenditure remains high and mainly affects the poorer population quintiles. A dual system seems to have emerged where wealthier population groups are switching to the private sector