Bulletin of the World Health Organization

The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?

Mylene Lagarde, Natasha Palmer

Volume 86, Number 11, November 2008, 839-848

Table 4. Main characteristics of studies on abolishing user fees and its effects on health service utilization in low- and middle-income countries, according to literature review

Study Study setting Study design Intervention Quality assessment Overall risk of bias
Burnham et al. (2004)25 Uganda – sample of 78 public facilities from 10 districts ITSa Abolition of user fees in PHC facilities. National policy change Important confounding factors and changes occurred at the same time; few points before; use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature High

Nabyonga et al. (2005)35 Uganda – sample of public facilities (13 referral hospitals and 59 health centres) and private facilities ITSa Abolition of user fees in PHC facilities. National policy change Important confounding factors and changes occurred at the same time; use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature High

Wilkinson et al. (2001)26 South Africa – a mobile unit in KwaZulu/Natal ITSa Abolition of user fees in PHC facilities. National policy change Many confounding factors; selection bias for the unit of analysis (1 mobile unit whose catchment area varies during the study); use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature High

Collins et al. (1996)22 Kenya – 4 district hospitals and 3 provincial hospitals ITSa Abolition of (recently introduced) user fees in hospitals and health centres. National policy change Presence of confounding factors, few observations for different stages; use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature High

Moses et al. (1992)24 Kenya – Nairobi’s special treatment clinic for STIs ITSa Abolition of (recently introduced) user fees in the national referral structure for STIs. National policy change Presence of confounding factors; few observations before the intervention; specific unit of analysis (referral centre for STIs); use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature High

ITS, interrupted time series; PHC, primary heath care; STIs, sexually transmitted infections.a Longitudinal data were reanalysed by the authors of the review, so that the results do not necessarily reflect the conclusions and views of the authors of the original paper.

[an error occurred while processing this directive]