The User fees, applied in some public health units in Mozambique, are not directly related to the need for the sector to obtain alternative sources for its sustainable functioning.  The study also found out that user fees are regressive, contributing substantially to the exclusion of poorest people and practice of corruption.

“In other words, user fees have a negative impact mainly in rural areas, where people are most financially disadvantaged”, the study adds, acknowledging that user fees create inequality and corruption.

“The introduction of user fees should exclude the poorest people, in order to improve the quality and equity of services”, says dos Santos, stressing that budget deficits, verified in this sector and the need to improve the quality of health care, contribute to the fact that fees collectors are more concerned about money.

Denzel dos Santos

Impact of User Fees Removal

The study also points out that user fees contributed to the significant reduction of use public health services usage.

“Therefore, there is a need to remove user fees in order to guarantee equity in the provision of health care to different social classes”, says the researcher, warning that, however, the elimination these fees, without any alternative measure of revenue collection, makes the provision of health services difficult, since direct payments for access to health services, based on demand, contribute to improving the quality of these services.

“Even so, in Mozambique, user fees have not contributed to better services. On the contrary, services tend to deteriorate”, he revealed.      

Challenges of User Fees Usage

As a challenge, according to Dos Santos, the government must guarantee the increase the budget for the health sector, improve efficiency in budget allocation to the sector, and make services more flexible for all Mozambicans, as well as increase the supply of qualified health professionals to meet the demand for health services.

“The removal of the user fees increases the demand for healing consultations, in greater proportion. However, this removal leads to losses in consigned revenue and an increase in consultations that give rise to a tiny growth in current expenditure in the National Health System”, the study points out.

The removal benefits the population, especially the poorest and those living in the most disadvantaged areas.

The position of the Ministry of Health (2010), states Dos Santos, is that the revenue from user fees applied in Mozambique is not very significant when compared to the total expenditures incurred by the sector.

“There is a need for the health sector to increasingly search for alternative sources of financing, taking into account the shortages that the sector presents, especially for the poorest people, who struggle with insufficient medicines, medical-surgical material, and lack of infrastructure, among other factors, which contribute to the sector’s inability to provide quality services for the population”, says the researcher.

Denzel dos Santos

Experience from Uganda and South Africa  

On the same occasion, representing Uganda, Labila Musoke, a researcher from the Initiative for Social and Economic Rights (ESER), presented a study that points out that user fees in the Ugandan Health System represent a barrier for the most disadvantaged populations.

“The fees do not benefit the poorest. On the contrary, they limit people in their access to health care”, said the researcher, adding that “in Uganda, when you are poor, you don’t have health care.”

People, when they can’t afford fees, according to Musoke, don’t have medical assistance, and researches point out that the fees don’t benefit the poorest.

Labila Musoke

For her part, researcher Lauren Paremoer, who shared the experience of South Africa, agreed that user fees hurt and intimidate the most disadvantaged communities in accessing health care.

“The fight against Apartheid was also about fighting for basic health services for the most disadvantaged populations. To this day, the struggle for a more qualitative health care system continues”, sys the researcher.


According to Paremoer, user fees were supposed to address the main challenges of the health sector “however, it is still seen lack of doctors and medicines in rural and more disadvantaged areas.”

“Therefore, user fees are found to be a barrier to access to health care, especially in South Africa”, she stressed.      

The findings are part of the studies carried out by the Citizen Observatory for Health (OCS), published at the Conference on Access to Health, which took place between June 30 and July 1, in the Mozambican capital, Maputo.    

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