Health financing for universal coverage

The elimination of user fees in Uganda: impact on utilization and catastrophic health expenditures

Discussion paper, Number 4/2005

World Health Organization

Publication details

Number of pages: 25
Publication date: 2005
Languages: English
WHO reference number: EIP/HSF/DP.05.4



All user fees at first level government health facilities in Uganda were removed in March 2001. This study explores the impact on health service utilization and catastrophic health expenditures using data from National Household Surveys undertaken in 1997, 2000 and 2003. It controls for other possible determinants using regression.

The abolition of user fees had different impacts on the poor and the non-poor. There was no clear change in either utilization or catastrophic expenditures in the non-poor. However, in the poor, utilization of public facilities increased substantially after the abolition of fees, but unexpectedly, the incidence of catastrophic expenditure did not fall.

A possible explanation is that frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies, with the extra payments for pharmaceuticals offsetting the reduction in payments for consultations. The study illustrates the complexity of developing financing systems in sub-Saharan Africa that allow people to access needed services but which also protect them against the financial risks of accessing care.