Financing health services through user fees and insurance: by R. Paul Shaw, Martha Ainsworth

By R. Paul Shaw, Martha Ainsworth

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Recent studies show that government expenditures on health can be allocated far more efficiently, offering the prospect of extending basic services to larger numbers of people in Africa (World Bank 1994a). It is time for a stocktaking of experiences and lessons learned on these issues. 1: Mechanisms for Resource Mobilization for Health There are five main options for financing better health in Sub-Saharan Africa: User fees General systems of taxation Health insurance Charitable contributions Donor assistance earmarked for health.

5 Referral systems do not work well in many countries of SSA, as has been widely observed. The World Bank survey of thirty-eight SSA countries referred to earlier revealed that only a minority of anglophone and francophone countries with cost recovery have structured fees to promote appropriate use (Nolan and Turbat 1993). Most evident are higher fees for outpatient services at higher level facilities. Least evident are fee waivers at hospital out-patient clinics for those who were appropriately referred upwards from local health centers.

238 Heath, Land Rights in Côte d' Ivoire: Survey and Prospects for Project Intervention No. 250 Rangeley, Thiam, Anderson, and Lyle, International River Basin Organizations in Sub-Saharan Africa No. 251 Sharma, Reitbergen, Heimo, and Patel, A Strategy for the Forest Sector in Sub-Saharan Africa No. 255 Mohan, editor, Bibliography of Publications: Technical Department, Africa Region, July 1987 to April 1994 No. 276 Johnson, Quality Review Schemes for Auditors: Their Potential for Sub-Saharan Africa No.

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