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Removal of User Fees at Primary Health Care Level in Zambia Improving Financial Access to Health Services 2-4 November 2010. Dakar, Senegal. Outline of the Presentation. Background to free health services- 70s/80s User fees introduction -1993 Pre - user fees policy removal-2004
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To assess the impact and processes of implementation of the user fee removal policy in Zambia’s health sector
While accounting for trends before and after
Indicator variable capturing the “Short-term” impact of the policy change
To determine the revenue impacts of user fee removal
On the ‘plus’ side:
On the ‘minus’ side:
District (basket) grant:
To explore drug availability around the time of fee removal
Days of stock-out per month 2005-2008, S/P & TEO, UF vs. UFR facilities
Drug availability mostly depending on supply-side factors
Additional challenges: roads, transport, qualified HR
Substantial additional support, sources outside of MSL
“There are drug shortages in that we are given fewer drugs. And I don't get better so we don't get the correct drugs. Before, I got better with the drugs I got” – female, 19 years, rural health centre
Rural health centres more affected
Mission hospitals less affected (more support)
“UFR has not changed anything for the patients, instead it has worsened their suffering because of no medicine” – M&E officer, rural health centre
To assess the impact of the removal of user fees on measures of staff motivation & job satisfaction
Methods & analysis
“ On the part of patients, it has encouraged them to come to the health centre whenever they feel unwell, unlike when they had to work for the user fee before they are attended to. Now everyone, also the poorest, can come. On the other hand, the health centre is struggling in raising enough funds to run it because money from the government is not enough. I suggest if the government would increase and not the patients to pay” – pharmacy dispenser, rural hospital