Impact of user fees on health facility utilization

Since the introduction and implementation of healthcare financing reforms, there has been a growing debate at different levels on whether or not the reforms are achieving the anticipated health outcomes. Many questions have been raised on user fees compromising equity issues in accessing medical care. This study analyses the impact of user fees on public health facilities utilization and assess the protection mechanisms that are used to ensure that cost recovery efforts do not restrict the access of the poor to health services. The study employed both primary and secondary data sources. The primary research data were obtained through questionnaire surveys and oral interviews. Secondary research data were obtained from previous studies (Literature review) on the same topic. The study involved 210 patients and 15 health workers working in different hospital sections. All respondents were required to give their knowledge and perceptions about awareness on user fees introduction at public health facilities. The results showed that the majority of patients (79%) and health workers (90%) respectively were aware about the existence of user fee policy as envisaged in National health policy. Our findings in the field also revealed that 29% of patients were aware of the presence of local arrangement of user fee waivers and exemptions following health financing reforms. Many people are aware about the presence of user fee policy in the country, but are not aware of the exemptions and waivers that are available to ensure that all have access to health services.