Impact of User Fees on Access to Quality Health services for Women in Solwezi District
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User fees are generally used in government institutions as a means of alleviating pressure on constrained budgets. In 2006, the Zambian Government abolished user fees in all rural areas except urban areas and municipalities like Solwezi. The Government took this position because of the overwhelming poverty levels in the country, the high cost for accessing health care services and the desire to ensure that a base for improving health outcomes was firmed up through the formation of the fundamental elements for attaining universal access.The purpose of this study was to determine the impact of user fees on the quality of health services for women in Solwezi District. The study was conducted at three health facilities: Solwezi General Hospital, Urban Clinic and Kimasala Clinic. The study population included all women aged 15 to 55 years. Data was collected using a structured questionnaire administered to 428 women and a focus group discussion guide administered to 20 women. Data was analysed using Epi-info computer software package. The Chi-square (x2) test was used to test for significant associations. Statistical significance was achieved if P<O.05. The results revealed a significant association between non affordability of user fees and person responsible for intra-household decisions on finances. Most decisions were made by both wife and husband but the later had the final say (42.76%).Almost all the respondents agreed to be paying user fees. Non affordability was also closely associated with how much was paid for user fees. The charges were mostly less than K5, 000 (67.92%). These charges were unaffordable to most women because 44.39% of them were unemployed. Furthermore, a significant association was observed between women turned away and the amount paid. At least 61.45% of the women reported to have been sent away at one time.Another significant association was observed between women turned away and the selling of household goods (p<O.OOl) and borrowing of money (p<O.OOl). Consequently, we conclude that user fees have a negative impact on women's access to quality health care. The major factors contributing include unemployment, low education levels, amount charged for health services, cultural factors and the person responsible for intra-household decision on finances. We can, therefore, recommend that user fees be abolished completely. The Government should increase funding to the health sector to offset the loss of income from the removal of user fees.