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Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue.

Opwora A, Waweru E, Toda M, Noor A, Edwards T, Fegan G, Molyneux S, Goodman C - Health Policy Plan (2014)

Bottom Line: With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect.In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups.However, the potential to ensure adherence was constrained by the facilities' need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities.

View Article: PubMed Central - PubMed

Affiliation: Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, Kenya, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, Kenya, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine, Oxford OX3 7LJ, UK, MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK and Department for Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK.

No MeSH data available.


Related in: MedlinePlus

Percentage of facilities adhering to user fee policy (N = 248). Source: In-charge interviews.
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czu026-F1: Percentage of facilities adhering to user fee policy (N = 248). Source: In-charge interviews.

Mentions: When adherence was assessed across all eight tracer conditions combined, including laboratory fees, none of the facilities adhered fully to the official user fee policy (Figure 1). When the services were analyzed individually, adherence was highest for an adult with tuberculosis (62.2%), followed by a child with pneumonia (53.7%). Adherence was lowest for an adult with malaria (4.2%) and an adult with gonorrhoea (4.3%). When laboratory fees were excluded from stated user fees, we still found that no facilities reported adhering to the policy across all tracers, with similar patterns of adherence across age and illness groups. The degree to which patients were over-charged (including laboratory fees) varied from a median of zero for an adult with TB and a child with pneumonia, to KES 40 (USD 0.53) for an adult with malaria and KES 50 (USD 0.66) for an adult with gonorrhoea (Table 2). Particularly high levels of over-charging were reported in non-municipal health centres for first ANC visit and delivery [medians of KES 120 (USD 1.58) and KES 150 (USD 1.97), respectively].Figure 1


Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue.

Opwora A, Waweru E, Toda M, Noor A, Edwards T, Fegan G, Molyneux S, Goodman C - Health Policy Plan (2014)

Percentage of facilities adhering to user fee policy (N = 248). Source: In-charge interviews.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385819&req=5

czu026-F1: Percentage of facilities adhering to user fee policy (N = 248). Source: In-charge interviews.
Mentions: When adherence was assessed across all eight tracer conditions combined, including laboratory fees, none of the facilities adhered fully to the official user fee policy (Figure 1). When the services were analyzed individually, adherence was highest for an adult with tuberculosis (62.2%), followed by a child with pneumonia (53.7%). Adherence was lowest for an adult with malaria (4.2%) and an adult with gonorrhoea (4.3%). When laboratory fees were excluded from stated user fees, we still found that no facilities reported adhering to the policy across all tracers, with similar patterns of adherence across age and illness groups. The degree to which patients were over-charged (including laboratory fees) varied from a median of zero for an adult with TB and a child with pneumonia, to KES 40 (USD 0.53) for an adult with malaria and KES 50 (USD 0.66) for an adult with gonorrhoea (Table 2). Particularly high levels of over-charging were reported in non-municipal health centres for first ANC visit and delivery [medians of KES 120 (USD 1.58) and KES 150 (USD 1.97), respectively].Figure 1

Bottom Line: With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect.In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups.However, the potential to ensure adherence was constrained by the facilities' need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities.

View Article: PubMed Central - PubMed

Affiliation: Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, Kenya, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya, Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, Kenya, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine, Oxford OX3 7LJ, UK, MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK and Department for Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK.

No MeSH data available.


Related in: MedlinePlus