User fees were introduced in Uganda in the late 1980s against a background of poorly funded health systems and strong international support for the role of user fees in encouraging community participation and ownership and for their value in generating revenue. By the late 1990s, there were conflicting opinions about the effect of user fees on access to health services particularly by the poor and other vulnerable groups, in Uganda and other developing countries. In March, 2001, user fees were abolished in all public health units in Uganda except for private wings in hospitals. Abolition of user fees is only one of a number of reforms introduced in the health sector in Uganda since the turn of the century. To assess the impact that this policy change has had on the health sector, this paper draws on evidence from a number of different sources including data from the Ministry of Health, the World Health Organisation, Participatory Poverty Assessment Reports and the Uganda National Household Surveys. The data points to a significant and immediate increase in utilisation of health services following the abolition of user fees, in particular by the poor. The paper concludes that user fees may be a bigger barrier to health service access for the poor than was previously envisaged in developing countries. Furthermore, in order for sustained improvements in health service utilisation, the policy of abolition of fees should be implemented simultaneously with supply side reforms.
In: Tashobya, C.; Ssengooba, F.; Oliveira-Cruz, V. (eds), Health systems reforms in Uganda: processes and outputs, London: Health Systems Development Programme, LSHTM, chp 3, pp 45-60, SBN: 0 902657 77 1, 2006.