By Brian Nolan
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Extra info for Cost recovery in public health services in Sub-Saharan Africa
5. De Ferranti (1985) argues on this basis that in some instances fees may be appropriate, even if the cost of collecting them exceeds the revenue raised. 6. Mwabu, Ainsworth, and Nyamete (1993) emphasize that concentrating on the impact of charges on the use of government health services will overstate the impact on demand for modern medical care, because there will be some diversion to missionary health facilities and private care. Page 14 7. Gertler and van der Gaag (1990), 1057, do assess the implications of their estimated demand functions for Côte d'Ivoire for shifting demand from hospital to clinic as a result of higher fees for hospitals.
Those involved in providing health care will be interested not only in the prospect of improving the service but also in improving their own workload and reward. How facility cost recovery is measured will also affect incentives: for example, some Page 10 performance indicators can create incentives to maximize pharmaceutical sales. It will also matter whether those responsible for collecting revenue make the spending decisions or whether such decisions are taken by those working at the facility, or by local community representatives.
For example, focused group discussions of health care practices or individual cases demonstrating the impact of improving services on demand tend to highlight quality, particularly the availability of drugs. 8 In reviewing the experience of African countries with user fees, then, it will be necessary to keep foremost in mind the relationship between charges and the quality of care. If the focus is on the provision of basic health services (as explained above), indicators such as trends in total expenditure on local government health facilities or the aggregate supply of drugs to those facilities will sometimes be available.
Cost recovery in public health services in Sub-Saharan Africa by Brian Nolan