ArticleBMC health services research2016
The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: a longitudinal, quasi-experimental study.
Article in BMC health services research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Health service utilization and associated factors among fee waiver beneficiaries in Ethiopia: Systematic review and meta-analysis.PloS one · 2025Pooled it
- Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps.AIDS (London, England) · 2018Pooled it
- 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
- Overuse of head CT scans in non-traumatic paediatric cases in the West Bank, Palestine: a cross-sectional study.BMJ open · 2025Article
- Unlocking health equity by eliminating copayments for essential antihypertensive medications.EClinicalMedicine · 2025Review
- Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.PLOS global public 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
- Observational
- The role of community health workers in influencing social connectedness using the household model: a qualitative case study from Malawi.Global health action · 2022Article
- Assessment of utilization of health care services and the associated factors among adult fee-waiver beneficiaries in Hawassa, southern Ethiopia: A community based cross sectional study.Journal of public health research · 2022Article
- How equitable is health spending on curative services and institutional delivery in Malawi? Evidence from a quasi-longitudinal benefit incidence analysis.International journal for equity in health · 2022Article
- Primary care doctor and nurse consultations among people who live in slums: a retrospective, cross-sectional survey in four countries.BMJ open · 2022Article
- Factors influencing HIV testing and counselling services among men who have sex with men in Western China: a cross-sectional study based on Andersen's Behavioral Model.Environmental health and preventive medicine · 2022Article
- Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical Cancer prevention and control strategy (2016-2020).BMC public health · 2021Review
- Model strategies to address barriers to cervical cancer treatment and palliative care among women in Zimbabwe: a public health approach.BMC women's health · 2021Article
- Determinants of healthcare seeking and out-of-pocket expenditures in a "free" healthcare system: evidence from rural Malawi.Health economics review · 2020Article
- Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage.Globalization and health · 2020Article
- Effectiveness of antimalarial interventions in Nigeria: Evidence from facility-level longitudinal data.Health services research · 2019Article
- Quality of primary care from patients' perspective: a cross sectional study of outpatients' experience in public health facilities in rural Malawi.BMC health services research · 2018Article
Corrections and comments
- Erratum issued
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUser fees have generally fallen out of favor across Africa, and they have been associated with reductions in access to healthcare. We examined the effects of the introduction and removal of user fees on outpatient attendances and new diagnoses of HIV, malaria, and tuberculosis in Neno District, Malawi where user fees were re-instated at three of 13 health centres in 2013 and subsequently removed at one of these in 2015.
methodsWe conducted two analyses. Firstly, an unadjusted comparison of outpatient visits and new diagnoses over three periods between July 2012 and October 2015: during the period with no user fees, at the re-introduction of user fees at four centres, and after the removal of user fees at one centre. Secondly, we estimated a linear model of the effect of user fees on the outcome of interest that controlled for unobserved health centre effects, monthly effects, and a linear time trend.
resultsThe introduction of user fees was associated with a change in total attendances of -68 % [95 % CI: -89 %, -12 %], similar reductions were observed for new malaria and HIV diagnoses. The removal of user fees was associated with an increase in total attendances of 352 % [213 %, 554 %] with similar increases for malaria diagnoses. The results were not sensitive to control group or model specification.
conclusionsUser fees for outpatient healthcare services present a barrier to patients accessing healthcare and reduce detection of serious infectious diseases.
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