Health is a human right that must be free from discrimination. Yet throughout the Global South, user fees continue to prevent the poor from accessing life-saving health services.
User fees for essential services were widely imposed as part of structural adjustment programs in the 1980s and 1990s. Today they act as an unjust rationing system by excluding the poorest and most marginalized members of society from accessing health care.
Countries such as Sierra Leone have demonstrated that with robust support from international partners, removing user fees for health care can improve health outcomes for the poor. But too few partners are stepping up to the plate. Donor support for user fee abolition and concurrent reforms - including hiring, training, and fairly compensating public health workers, procuring additional medicines and supplies, and increasing financial flows to front line services - is requisite to ensuring effective and equitable health services in low-resource settings.
It is time bilateral and multilateral donors answer this call to action by acknowledging: (1) the negative impacts of user fees on poor people’s access to health care, and (2) their commitment to working with countries to eliminate these fees without requiring specific pre-conditions.