The influence of user fees in improving the health services in Korogwe district

To determine the extent to which user charges has contributed to improvement of health services following the introduction of health sector reform, a cross sectional study was conducted in Korogwe hospital in June 2002. The study subjects included, 412 community members, 80 health workers, and 40 patients. Data collection instruments included a structured interview schedule and focus group discussions using an interview guide. The results showed that there was a moderate improvement in quality of care, especially in process quality as assessed by level of interaction between providers and clients. The level of satisfaction with the health services was 65% among community subjects. The mean number of drugs per prescription form was 2.5±0.6. Forty three percent (43%) of community members and 90% of patients were of the opinion that quality of care had improved following introduction of user fees. Over a half (57%) of the community subjects perceived that there had been very little improvement in the structure of buildings and 44.9% had knowledge about the changes regarding user fees in the district hospital. Some of the patients and of community members were unable to pay user fees, however only 33% and 13% of the above were granted an exemption respectively. Overall, 70% of the community subjects mentioned that they would not be willing to pay more money as user fees. The study recommends that further improvement be made on structural and process quality of care so that the community and patients can maximize benefits of user fees at the district level. Health workers should also be trained to improve their behavior and drugs be made more readily available so as to synchronize with increasing patient demand and accountability of user fees.