I can’t imagine living in a world where my doctor would offer me an upgraded and higher quality physical examination for a few extra dollars. In Uganda, ranked the 19th least developed country by UNICEF, informal user fees have been a common practice between patients and health workers. Despite providing free public health care for years, Ugandan health workers were working inside a failing healthcare system with increasingly low salaries. The informal user fees provided the health worker with a little extra cash and the patient was able to receive better health services in return. The government tried to increase funding for healthcare through raised taxation, but were mainly unsuccessful. Financial burdens became too much for the Ugandan government to handle alone and health reform was more than welcomed if any agencies were willing to help.
International agencies such as the World Bank and the Ministry of Health stepped in to provide aid for the failing Ugandan health system. At a vulnerable state, these agencies had the position to greatly influence the structure of the healthcare system. In 1987, the Health Policy Review Commission encouraged the practice of formal user fees, a practice already in place in Uganda. The user fees would create internal revenue for the healthcare system. However, the free public health system that was already in place was a huge benefit for the developing nation. The country could barely pull itself out of economic burden by increasing taxation; how would these vulnerable populations be able to afford the extra healthcare cost?
International agencies are too focused on the financial state of a country and do not focus enough on the health of its inhabitants. Increasing funding for a healthcare system may not directly translate into better primary health care, especially in a developing country such as Uganda. International agencies should build upon the healthcare structures that are already in place and increase the independence of developing nations like Uganda.
For more information:
Okuonzi, S. A., & Macrae, J. (1995). Whose policy is it anyway? International and national influences on health policy development in Uganda. Health Policy and Planning, 10, 122–132.