The presentation gives a brief overview of the concept of the following : 1. what are user chargers 2. should we abolish them or not. 3. What could be the impact of either keeping them or abolishing them, 4. What role would the abolishment of User Charges play in achieving the goal of Universal Health Coverage?

1. Abolishing User
Charges

2. Out of Pocket Expenditure
• Payments made by households at the point of receiving health services.
• Includes - Spending on alternative and/or traditional medicine but
• Excludes - Expenditure on transportation to obtain care and special nutrition.

3. Catastrophic Health Expenditure
• Capacity of a Household to pay for Health.
• Financial catastrophe when its total out-of-pocket health payments equal or
exceed 40% of its non-subsistence expenditure.

5. Should User Charges be
Abolished or Not ???

6. Advantages of Abolishing User Charges
1. Improved access to health care services
2. Decrease in out of pocket payments
3. Increased equity by ensuring financial protection of the poor

7. Disadvantages of Abolishing User Charges
1. Increase in coverage of Curative
Services as compared to Preventive
Services
2. Increase in Patient load
(Congestion)
3. Poor provision of Quality of Services
- Unavailability of Drugs
4. Overloaded Health workers
5. Delay in reimbursement
6. Disruption in HIS – Lack of adequate
Healthcare workforce.
7. Does not bring much change in
Service utilization. (Sweden)
8. Emergence of Dual System for
Healthcare
9. Lack of clear governance and
leadership

8. Plenary Discussion
What are key factors in effective implementation of
abolition of user charges from public health facilities?

9. Few Factors
1. Analysis of country’s initial position
2. Specific government unit
3. Communicate clearly with health workers and managers
4. Establish new funds at local level, for small-scale spending decisions
5. Before the policy change, wide range of public information campaign
6. Adequate drugs and staff to be available
7. “Close to client” services
8. Establish monitoring systems

10. References
1. Wilkinson D, Gouws E, Sach M, Karim SS. Effect of removing user fees on attendance for curative and
preventive primary health care services in rural South Africa. Bulletin of the World Health
organization. 2001;79:665-71.
2. Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Aguilar AM. The elimination of user fees in Uganda:
impact on utilization and catastrophic health expenditures. WHO, Genf (http://www. who.
int/health_financing/The% 20elimination% 20of% 20user% 20fees% 20in% 20Uganda% 20% 20DP.
05.4. pdf. 2005.
3. Ridde V, Robert E, Meessen B. A literature review of the disruptive effects of user fee exemption
policies on health systems. BMC Public health. 2012 Dec;12(1):289.
4. Farrants K, Bambra C, Nylen L, Kasim A, Burström B, Hunter D. The recommodification of healthcare?
A case study of user charges and inequalities in access to healthcare in Sweden 1980–2005. Health
Policy. 2017 Jan 1;121(1):42-9.
5. Lépine, A., Lagarde, M., & Le Nestour, A. (2018). How effective and fair is user fee removal? Evidence
from Zambia using a pooled synthetic control. Health economics, 27(3), 493-508.