[afro-nets] RFI: User fees in health services in Africa (4)

["Peter Burgess" <peterbnyc@gmail.com>]

Dear Colleagues

The subject is user fees in health services in Africa.
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Loubna Belaid asked:
>> I am a student working with Mr Valéry Ridde. I am doing a review of literature about user fees in health services in Africa. Mr Valéry Ridde asked me to contact you to see if you have any documents that will help us to do a detailed review of literature about this topic? 

Kigozi Isaac replied:
>> Hello Loubna, there is some work that was done on user fees in Uganda and their effects as well as the effects of their abolition by WHO http://www.who.int/health_financing/The%20elimination%20of%20user%20fees%20in%20Uganda%20%20DP.05.4.pdf. I think if you did a Pubmed search you would easily find the details. There have been other studies done in Kenya and Malawi I think.
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I had a look at the WHO report referenced above. This study was, I thought, rather typical of so many studies that have been done over the years ... but whose purpose and value is not really clear.

I always do the cost --> price --> value analysis on any activity ... and it is always that there is cost ... and quite rare that there is value. We know there are 6 authors, so the cost was not inconsequential. But, I am afraid, I can find little in the study that helps very much to make the world a better place. As a result of this study ... what exactly would anyone do different?

It would be interesting to go through 30 references cited and do the cost --> price --> value analysis on all of them.

My own take on health sector studies is that there would be much more valuable information if the studies were put into an broader economic perspective ... looking not only at the family, but also the local community where the family lives and the family earns their livelihood ... and looking also at the health sector including both the public sector government financed segment and the private segment. The economic and financial situation for the nation as a whole also factors in. How much do various activities in the health sector cost? What about availability of nurses? What about money to pay nurses salaries? What about availability of medicine and medical supplies?

As regards user fees ... were there any surprises in this study? Not really. But the idea that health and "catastrophic" anything should be a result, was rather disconcerting.

I have seen some excellent studies of the health sector in Africa ... about the financing needs and the availability of financing. But most of the studies are not in this class ... and as far as I can see, only serve to occupy the time of the researchers and give them an opportunity to be "published". This is important to the individuals concerned ... but is not very valuable for the public at large.

The "expert" community has written a huge amount about health in Africa, but rather little of this work is of much value in terms of facilitating practical solutions to the crisis of the abysmal health status in Africa. The basics of accounting are ignored ... transparency is frowned upon ... and theoretical constructs abound. The essentials of management information are needed ... and soon. More money is only going to help if it can be used in cost effective ways ... and not merely increase the amount of money wasted. Surely this is something that studies should be addressing.

Sincerely

Peter

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Peter Burgess
The Transparency and Accountability Network: Tr-Ac-Net in New York
http://www.tr-ac-net.org
IMMC - The Integrated Malaria Management Consortium Inc.
http://www.IMMConsortium.org
+1 917 432 1191 or +1 212 772 6918  
mailto:peterbnyc@gmail.com