How do fee-for-service plans and privatization affect health care provision?
Not surprisingly, charging for health care limits access. And user fees are a central feature of the fee-for-service schemes that the IMF and Bank push in their structural adjustment and sectoral adjustment programs. One World Bank report argued that the pre-1980s policy of many African states “to treat [health care] as a right of citizenry and to attempt to provide free services to everyone … prevents the government health system from collecting revenues that many patients are both able and willing to pay.” Another report added, “When a service costs money, people will think twice about demanding it.” When the World Bank mandated that Kenya impose charges of US$2.15 for STD clinic services, attendance fell 35 to 60 percent, with similar results seen throughout the developing world. What does this mean in people terms? Here is how Njoki Njoroge Njehû, who is from Kenya and now direct the 50 Years is Enough campaign, describes her experience: “When I was a young girl growing up near N
