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 5. Main characteristics of studies on reducing 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
Ojeda et al. (1994)28 Colombia – 4 groups of 3 clinics (1 control, and 3 interventions) CBA Decrease of charges for a contraceptive implant Net prices may be misleading due to inflation; some minor differences between baseline and control groups; statistical significance computed by the reviewers High

Abdu et al. (2004)31 Sudan – 6 public health centres (2 × 3 interventions) and 2 control ones CBA Decrease of user fees in PHC facilities Important differences between control site and treatment sites (catchment area size, rural/urban, outcome results); limited sample size for women at baseline; inappropriate statistical analysis (and no significance level computed) High

CBA, controlled “before and after”; PHC, primary health care.

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