The Removal of User Fees

The question of whether or not to remove user fees for healthcare services in developing countries seems, on the surface, to have a simple and logical answer.  The main argument for removing the user fees is that since those needing the services are too poor to pay, these fees are causing  the poor to forego the healthcare they need.  In the article “Public Spending on healthcare in Africa: do the poor benefit?” (Bulletin of WHO, 2000), a study shows that the bottom fifth of the poor in a number of African countries, such as the Ivory Coast, Ghana and Guinea, do not obtain any medical services at all (73%, 59% and 60%, respectively), due to lack of access in their rural area, or due to lack of disposable income.  By imposing new user fees, or maintaining a current user fee program, this situation will certainly not improve and may very well worsen.

Another side of the argument claims that if no user fees are collected, the lack of funds may adversely impact the availability of rural medical services, as the fees are needed to pay for facilities, medical supplies and medical personnel.  However, in the article referenced earlier, “Public Spending on healthcare…” (Bulletin of WHO, 2000), it states that when a government does spend resources, it normally goes towards urban hospitals, used by the wealthier portion of the population, not towards those who need it the most. 

Instead of relying on user fees, one solution discussed in the article “Universal health care and the removal of user fees” (Yates, 2009) is to use a more robust partnership approach to paying for medical services, such as between the government of a developing country and an international donor. These funds would be earmarked specifically to pay for the development and maintenance of a medical infrastructure that is by necessity, easily accessible by the rural poor.  Current sources of funding for healthcare is approximately  15% from a host government  and approximately 35-50% from international donors (Equitable Health care Financing and poverty challenges in the African context; September 2005, The funding amount from donors can be increased until a country’s healthcare system is strong and viable.

Another option for paying for a healthcare system is through tax revenue. By increasing the tax on the wealthier segment of the population, the additional revenue can be funneled to the implementation and sustainability of a rural healthcare system.  However, the fear of corruption may cause one to hesitate with this option, as how would one ensure that the tax revenue reaches its target?

In an article on (Voice of America), dated May 18, 2010, Ellen Sirleaf, the President of Liberia, made the following statement: “In our own case in Liberia, we committed to making permanent our temporary suspension of users’ fees and to providing free health care for all depending on the continuing support of adequate donor finance to make this possible… “Offering free health care services at all public health facilities has significantly increased outpatient attendance across the country.”  This is then the most simple and logical answer.


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