Poverty and user fees for public health care in low-income countries: lessons from Uganda and Cambodia

Abstract

We should note some important caveats from comparison of the two policies. For example these two strategies took place in different countries and quality of governance is not equal. According to the 2004 World Bank survey on governance government effectiveness and control of corruption are better in Uganda than in Cambodia. Yet similarities between the two countries do exist--eg around 40% of the population below the international poverty line of US$1 per day a health sector largely dependent on donors a public health system built on the health district model and some achievement in terms of containing the HIV/AIDS epidemic. We should also acknowledge that the two policies were not implemented as stand-alone policies. In Uganda the abolition of user fees was accompanied by a substantial investment in the health-care system. In Cambodia the health equity funds were introduced in hospitals whose performance had been improved by contracting arrangements establishing higher staff motivation and improved quality of care. However in both countries the two strategies did not address all the difficulties of the health sector. (excerpt)