The Lessons of User Fee Experience in Africa
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TLDR
If introduced by themselves, fees are unlikely to achieve equity, efficiency or sustainability objectives and should, therefore, be seen as only one element in a broader health care financing package that should include some form of risk-sharing.Abstract:
This paper reviews the experience of implementing user fees in Africa. It describes the two main approaches to implementing user fees that have been applied in African countries, the standard and the Bamako Initiative models, and their common objectives. It summarizes the evidence concerning the impact of fees on equity, efficiency and system sustainability (as opposed to financial sustainability), and the key bottlenecks to their effective implementation. On the basis of this evidence it then draws out three main sets of lessons, focusing on: where and when to implement fees; how to enhance the impact of fees on their objectives; and how to strengthen the process of implementation. If introduced by themselves, fees are unlikely to achieve equity, efficiency or sustainability objectives. They should, therefore, be seen as only one element in a broader health care financing package that should include some form of risk-sharing. This financing package is important in limiting the potential equity dangers clearly associated with fees. There is a greater potential role for fees within hospitals rather than primary facilities. Achievement of equity, efficiency and, in particular, sustainability will also require the implementation of complementary interventions to develop the skills, systems and mechanisms of accountability critical to ensure effective implementation. Finally, the process of policy development and implementation is itself an important influence over effective implementation.read more
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References
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Journal ArticleDOI
Reforming the health sector in developing countries: the central role of policy analysis
TL;DR: It is argued that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform, the processes contingent on developing and implementing change and the context within which policy is developed.
Book
Health Policy: An Introduction to Process and Power
TL;DR: This work analyzes the complicated processes involved in the formulation of health policies and offers practical examples and explanatory text for health workers, managers and academics.
Book
Decentralization and development : Policy implementation in developing countries
TL;DR: In this article, Hidehiko Sazanami implementing Decentralization Policies, and G Shabbir Cheema and Dennis A Rondinelli implementing decentralization policies.
Book
Financing Health Services in Developing Countries: An Agenda for Reform
TL;DR: 4 policies for health financing are proposed to raise revenues for important health programs increase the efficiency of public health services and make the system better serve the poor.
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