Social determinants of health

Stories of positive action from around the world

Story numbers correspond to those in the Report.

Facilitating universal health care

9.12: Uganda – user fees imposition and abolition

Uganda introduced user fees on a universal basis in 1993. Although revenue generation was relatively low (generally less than 5% of expenditure), it was an important source of funds for supplementing health worker salaries, maintaining facilities, and purchasing additional drugs. However, there was a dramatic decline in the utilization of health-care services and there were growing concerns about the impact on the poor. User fees at public sector facilities were abolished in March 2001, with the exception of private wards. Utilization of health services increased immediately and dramatically.

The poor particularly benefited from the removal of fees. Utilization of health services (percentage who when sick sought professional care) increased from 58% to 70% in the case of the poorest quintile and from 80% to 85% for those in the richest quintile. National immunization coverage increased from 41% in 1999/2000 to 84% in 2002/03. This could not have been achieved without significant government financial support. Moreover, attention is required to other expenses such as drugs and transport costs, and the elimination of unofficial payments (Balabanova, 2007