Welcome to the Publication Archives of USAID-funded Health Policy Projects.

Browse POLICY Project (1995-2006) Materials

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  • Although user fees are increasingly being used in government health programs to alleviate the pressure on constrained budgets as demand for services increases, results in developing countries thus far have been mixed and concerns that fees reduce access to services among the poor have led to the promotion of fee exemption mechanisms. These exemptions, however, may not be an effective response because (1) informal fees and other costs associated with seeking and receiving services are not alleviated by most exemption mechanisms, and (2) exemption mechanisms are often poorly implemented. The low proportion of formal fees to total costs to the consumer and the unpredictable nature of informal fees may actually work against formal fee exemption mechanisms. Thus, it is important to assess whether these mechanisms alone hold promise for protecting access among the poor, or whether they need to be supplemented with other strategies. The objectives of this study were to: (1) survey actual costs to consumers for reproductive health (RH) care services including antenatal care (ANC), delivery care, family planning (FP), postabortion care (PAC), child healthcare, and reproductive tract infection (RTI) treatment; (2) review fee and waiver mechanisms; (3) assess the degree to which these mechanisms function as intended; (4) assess the degree to which residual costs to consumers (after accounting for fee exemptions) may constitute a barrier to these services; and (5) review current policies and practices on setting charges and collecting, retaining, and using fee revenue.
    India Maternal Health User Fee Paper.Country Report.FINAL.doc