User fees; health staff incentives; and service utilization in Kabarole District; Uganda

ABSTRACT

The Objectives of this study are To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District; Western Uganda. Methods: Of the 38 government health units that had introduced user-fee financing schemes; 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. Findings: After the introduction of cost sharing; overall utilization of general outpatient services; assessed by combining the data from all the participating units; dropped by 21.3. Utilization increased; however; in facilities located in remote areas; while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentives payments derived from cost-sharing revenues. Conclusions: Incentive payments led the health workers to offer improved services. Other factors may also have been influential; such as an improved drug supply to health facilities and increased public identification with community projects in remote areas