Ill-health is a major reason why many people remain poor in developing countries. Households headed by a sick individual are also more likely to become poor. In Uganda, the decision to abolish user fees for health care provides an opportunity to examine how primary services can help promote development and reduce poverty.

A paper published in the journal - Development Policy Review, looks at the impact of the Government of Uganda’s health policies and their contribution to the country’s progress in poverty reduction. User fees were introduced on an informal basis by districts and health units from the late 1980s. This was in the context of a poorly funded and poorly functioning health system. Donors provided much of the support for paying patient charges. Districts and health units set their own policies for exemption from paying the user fees, which mainly applied to civil servants, local councillors and soldiers.

Under this system, poor people were frequently made to pay charges or did not seek health care when ill. User fees also failed to raise much money to pay for services. Since then, the Government has introduced a number of new policies that encourage poor people to take advantage of free health care. Between 1995 and 2002, the Government introduced exemptions for poor people from user fees, and also developed community-based health insurance schemes. In 2001 it decided to abolish all user fees. This has been accompanied by reforms to improve basic health care.

Early research shows that abolishing user fees has made health care more accessible to poor people, and they have increased their use of these services. There have also been improvements in access and in the efficiency of services delivered in rural areas. Combined with the increased supply of health services, the results show:

• an 84 percent increase in demand for public health services between 2000/1 and 2002/3
• people are seeking health care at an earlier stage, reducing their risk of serious ill-health.
• poor households, especially the poorest 25 percent, have paid less for public health care
• better support to people has reduced the impact of unexpected events.

However, the full impact of abolishing fees and the introduction of reforms will not be known until the results of the next health survey are available.

Although abolishing user fees does not eliminate the actual risk of becoming ill, it may help to limit the seriousness of future illness. A continued lack of funding and policies that fail to address health risks mean that effective health care delivery is still not realised. To maintain progress, the Ugandan government must:

• manage the risk of becoming ill through the strengthening of basic health services
• increase the health budget to meet rising demands
• make further efforts to improve the health care seeking behaviour
• improve the quality of and access to health care for maternity services, so that women are less exposed to risks in childbirth
• give more attention to policy development in the social protection debate.

Source(s):
‘Social Protection and Health: Experiences in Uganda’, Development Policy Review, 24.3, pages 339-356, by Jenny Yates, Ros Cooper and Jeremy Holland, 2006

Funded by: UK Department for International Development

id21 Research Highlight: 24 January 2007

Further Information:
Jenny Yates
UK Department for International Development (DRC)
British Embassy
83 Avenue Roi Baudouin
PO Box 8049, Kinshasa
Democratic Republic of Congo (DRC)

Tel: +243 817 150 761
Fax: +243 813 464 291
Contact the contributor: j-yates@dfid.gov.uk

UK Department for International Development

Other related links:
'Medical bills push people deeper into poverty'

'Dispelling the myths of service delivery in South Africa'

'Understanding the causes of chronic poverty in Uganda'

'Setting the right priorities for health development: donor responsibilities'

Eldis resource guide to health, poverty and vulnerability

Health Poverty Index