THE EFFECT OF ABOLITION OF USER FEES ON EQUITY AND THE QUALITY OF HEALTHCARE SERVICES : The case of Uganda’s healthcare sector .

Abstract

Background: Many African countries introduced user fees supported by the World Bank in the 1980s. But most of these countries have now embarked on abolishing user fees due to its negative impact on access to health care. In Uganda, user fees were abolished in all public health facilities in 2001. The World Bank’s participatory poverty assessment report (1999) reported lack of access and deteriorating standards of care. Literature shows that the abolition of user fees resulted into increased demand for health services in all public health facilities. In spite of the abolition of user fees in public health institution, the quality and equity of healthcare services in Uganda’s healthcare sector remained low. This is attributed to poor reimbursement system, high cost of drugs and inadequate man power.

Objectives The purpose of this study was to find out how the healthcare sector in Uganda is financed after the abolition of user fees in public institutions. The study was also intended to find out how the government reimburses public health workers after the abolition of user fees. The research also aimed at finding out how this affects the quality and equity of services delivered by health workers to patients.

Method I analyzed secondary information and materials from different organizations. Data was obtained through in-depth review of both local and international literatures. The information was obtained from different websites including World Health Organization (WHO), World Bank, Uganda National Bureau of Statistics, Ministry of Finance, Ministry of Health and other literature sources. I also collected hard copies of different documents from different ministries. The study provides qualitative methods. The variables used to discuss the effect of the abolition of user fees on quality and equity in healthcare services are, hospital catchment area, motivation, the level of income of health workers, healthcare financing, ratio of doctor to patients, capacity of hospitals, availability of drugs and the funding mechanism.

Results Mortality rate infant per 1000 live births improved from 155in 1998 to 115 in 2006 and mortality rate under five per 1000 live births also improved from 93.5 in 1998 to71.8 in 2006. Survival rate for both men and women shows an improving trend from 34.8 % in 1998 to 42.5 in 2006 for woman and 29.3% in 1998 to 40.1% in 2006 for men. Health workers level of income is still very poor at salary of US$250 per month. Health centers without drug stock out is not stable with increase from 33% before abolition of user fees to 40% in 2003 but later declined to 27% in 2006. Hospitals are over utilized. Ratio of doctor to patients is high at 1:24726.out of pocket expenditure is still high with 9% of household health care expenditure still spent on health. Donor’s funds are earmarked for specific diseases.

Conclusion After the abolition of user fees in public facilities, Uganda’s healthcare sector remained under funded leading to poor pay for health workers. The funding mechanisms used in financing the healthcare sector after the abolition of user fees may also undermine equity in healthcare services.