Impact and public perception of health service user fees: The case of high density residential Chawama Compound
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Zambia's health policy and strategies can be said to have evolved through four significant phases. First, was the pre-independence period whose health policies were influenced by the colour-segregation ideology. Secondly, immediately after independence health policies and strategies were formulated that aimed at eliminating the imbalances in the provision of public health. The third phase was the adoption of the Primary Health Care (PHC) approach to the provision of public health services in 1980. The PHC approach, however, did not perform as expected so much that when the MMD government took office in 1991, they embarked on health reforms whose core focus was the establishment of the District Health Boards as the basic management units. These Boards were in operation till 2007 when the Central Board of Health was abolished as the mother body.The overall purpose of this study was to investigate the impact of user fees on accessibility to health services and facilities in high density residential areas.The dissertation takes a case study of a high density residential area so as to investigate the impact of user fees on accessibility to health services and facilities.This case study was conducted in Chawama Compound of Lusaka District. In Chawama catchment area, four zones were covered which represent the diversity of the residential area where these respondents were picked. Within Chawama catchment area,there are Chawama and Lilayi clinics where part of the research was carried out. The total number of respondents in the catchment area was 332; 50 opinion leaders, 20 health providers, 10 traditional healers and 252 facility users. It was established that initially, people had accepted the idea of cost sharing where provision of public health services and facilities was concerned. Surprisingly enough, after the introduction of user fees, the majority of the people developed a negative attitude towards user fees. But people's reluctance in paying user fees is influenced by a number of factors. These include income, occupation, education, availability of quality services and sensitization. Income was not a major factor in determining people's attitudes towards user fees. But the most negatively affected are those who earn low incomes. Occupation and education also played a marginal role in influencing people's attitudes towards user fees. It was also found that the majority of people were reluctant to pay user fees because of inadequate or non availability of quality health services and facilities as well as lack of sensitization. Due to the factors indicated above, people resort to alternative sources of health. Alternative sources of health services include traditional healers, spiritual healers, private local drug stores, chemists and private clinics. The majority of people feel that user fees should be abolished.