ArticleGlobalization and health2013
Global health actors no longer in favor of user fees: a documentary study.
Article in Globalization and health, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Pay-it-forward gonorrhoea and chlamydia testing among men who have sex with men in China: a randomised controlled trial.The Lancet. Infectious diseases · 2020Trial
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Limited user fees for adult HIV diagnosis and routine laboratory monitoring in the global IeDEA consortium: analysis in 42 countries.medRxiv : the preprint server for health sciences · 2025Article
- Household costs of care in children under five attending primary care in Burkina Faso, Guinea, Mali and Niger: a cross-sectional study nested in the AIRE project.BMJ global health · 2025Article
- Improving healthcare accessibility for pregnant women and children in the context of health system strengthening initiatives and terrorist attacks in Central Mali: a controlled interrupted time series analysis.BMJ global health · 2024Article
- Barriers to access of maternal health commodities among pregnant women in public health facilities in Ubungo Municipal Council, Tanzania.Journal of pharmaceutical policy and practice · 2024Article
- Retracing loss of momentum for primary health care: can renewed political interest in the context of COVID-19 be a turning point?BMJ global health · 2023Review
- Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa.BMJ global health · 2022Review
- Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso.Reproductive health · 2022Article
- Interrogating the World Bank's role in global health knowledge production, governance, and finance.Globalization and health · 2021Review
- Community-funded integrated care outreach clinics as a capacity building strategy to expand access to health care in remote areas of Uganda.Global health action · 2021Article
- Effect of a prospective payment method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study.Health policy and planning · 2020Article
- A critical interpretive synthesis of informal payments in maternal health care.Health policy and planning · 2019Review
- Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey.Health economics review · 2019Article
- 'Rowing against the current': the policy process and effects of removing user fees for caesarean sections in Benin.BMJ global health · 2018Article
- Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.World journal of surgery · 2017Article
- Erratum to: 'Setting performance-based financing in the health sector agenda: a case study in Cameroon'.Globalization and health · 2017Article
- Setting performance-based financing in the health sector agenda: a case study in Cameroon.Globalization and health · 2017Article
- Health financing policies in Sub-Saharan Africa: government ownership or donors' influence? A scoping review of policymaking processes.Global health research and policy · 2017Article
- The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: a longitudinal, quasi-experimental study.BMC health services research · 2016Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
backgroundSince the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees.
methodsWe conducted documentary research using public documents published by and officially attributed to GHAs from 2005 to 2011. We categorized GHAs into four groups: intergovernmental organizations, international non-governmental organizations, government agencies, and working groups and networks. We then classified the GHAs according to their stance relative to the abolition of user fees, and conducted a thematic analysis of their discourse to understand the arguments used by each GHA to justify its stance.
resultsWe identified 56 GHAs, for which we analyzed 140 documents. Among them, 55% were in favor of the abolition of user fees or in favor of free care at the point of delivery. None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand. Only the World Bank declares that it is both in favor of user fees and in favor of free care at point of service. GHAs generally circumscribe their stance to specific populations (pregnant women, children under 5 years, etc.) or to specific health services (primary, basic, essential). Three types of arguments are used by GHAs to justify their stance: economic, moral and ethical, and pragmatic.
conclusionsThe principle of "user pays" seems to have fizzled. Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse. However, GHAs should go a step further and translate their words into action, so that free healthcare at the point of delivery becomes a reality in low- and middle-income countries. They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.