The elimination of user fees in Uganda - World Health Organization

More documents

Recommendations

Info

In Uganda, curative services are provided by a mix of public and private for-profit andprivate not-for-profit providers. Preventive interventions are provided by the public andprivate not-for-profit sectors. For curative care, there is no national health insurancesystem nor is the private insurance market well developed. A few small community-basedinsurance schemes exist. National health account estimates suggest that out-of-pocketpayments (OOPs) made by households at the point of services for such items asmedicines, tests and hospitalization have been in the order of 40-45% of total healthexpenditure over the last few years, typical of many countries in sub-Saharan Africa.(World Health Organization, 2004; Korte R, Richter H, Merkle F & Gorgen H, 1992) Theremaining funding is provided by government, with a substantial and growing componentof government expenditure derived from external sources such as donors and multilaterallending institutions.Health services in public facilities were free before 1993.(Burnham G M, Pariyo G,Galiwango E & Wabwire-Mangen F, 2004) Subsequent decentralization of public sectorservices delivery, including health care, gave the local district health authorities the rightto levy user fees for the services they rendered.(Deininger K & Mpuga P, 2004; JeppssonA, 2001; Kapiriri L, Norheim OF & Heggenhougen K, 2003) The result was considerablevariation across districts in how charges were levied. Some charged only for drugs;others charged for each service provided (e.g. consultation, laboratory tests, drugs,hospitalization); others charged flat fees where people paid a single annual fee whichentitled them to access any needed service; while some districts chose not to impose anyfees.(Kivumbi GW & Kintu F, 2002) Outpatients attending public hospitals had thechoice of a "free window" if they could not pay, or a "pay window" if they could.Similarly, public hospitals also provided private beds for people who could pay, while
offering free inpatient care to those who could not. There is some evidence that the supplyof medicines and the quality of services improved in some districts but, subsequentconcerns that fees prevented poor people accessing needed services led to the abolition ofall fees at first level public facilities in 2001.The total funds generated through user fees was less than 5% of total health expenditure.(Okuonzi S A, 2004) Upon the abolition of fees, government increased its funding fordistrict health services to enable them to bridge the funding gap created by this abolition.The abolition resulted, however, in an increase in utilization and as a result drug 'stockouts'became common in public health units.(Ministry of Health Uganda, 2004; WHOCountry Office Uganda & SIDA, 2003)This study explores changes in service utilization and catastrophic health expenditures atthree points during the period 1997 and 2003. The points span the period from just beforeto just after the abolition of user fees. Special attention is paid to changes among thepoor. The first part of this paper describes the available data, followed by a section ofmethodology. The next section describes the results followed by discussion andconclusions.Data and variablesData are from the nationally representative National Household Surveys (NHS) of 1997,2000 and 2003. The surveys included 6,655, 10,691 and 9,710 households in turn,comprising 33,988, 53,761 and 47,468 individuals respectively. The survey of 1997 wasincluded to allow for the fact that some changes might have been taking place before theremoval of user fees in 2001.
Page 1 and 2: World Health OrganizationGenevaEIP/
Page 3: The elimination of user fees in Uga
Page 8 and 9: The variables used in the analysis
Page 10 and 11: The regression models are applied t
Page 12 and 13: From equations (3) and (4), we obta
Page 14 and 15: 2000, but the difference did not re
Page 17 and 18: determinant of catastrophic expendi
Page 19 and 20: Ministry of Health Uganda,W.C.O.U.
Page 21 and 22: Table 1. Variables used in the anal
Page 23 and 24: Table 3. Coefficients in multinomin

The elimination of user fees in Uganda - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?