BMJ  2005;331:747-749 (1 October), doi:10.1136/bmj.331.7519.747

Paper

Impact on child mortality of removing user fees: simulation model

Chris James, health financing consultant1, Saul S Morris, honorary senior lecturer2, Regina Keith, health policy adviser1, Anna Taylor, head of basic services1

1 Save the Children UK, London EC1M 4AR, 2 London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: C James, Rustlings, Springwood Lane, Peppard, Henley-on-Thames, Oxon RG9 5JJ chrisjamesuk{at}hotmail.com

Objective To estimate how many child deaths might be prevented if user fees were removed in 20 African countries

Design Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services.

Results Elimination of user fees could prevent approximately 233 000 (estimate range 153 000-305 000) deaths annually in children aged under 5 in 20 African countries.

Conclusion Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.


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This article has been cited by other articles:

  • Choonara, I. (2008). WHO wants safer medicines for children. Arch. Dis. Child. 93: 456-457 [Full text]  
  • Ball, D. E (2005). Health in Africa: It's time for good guidelines on health financing practice. BMJ 331: 904-905 [Full text]  
  • Gilson, L., McIntyre, D. (2005). Removing user fees for primary care in Africa: the need for careful action. BMJ 331: 762-765 [Full text]  

Rapid Responses:

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Removing User Fees - An Immediate Necessity
Mukosha B Chitah
bmj.com, 30 Sep 2005 [Full text]
A reliable tool for low cost PMTs
Tarek Rashed Khater
bmj.com, 3 Oct 2005 [Full text]
It’s time for Good Health Financing Practice Guidelines
Douglas E Ball
bmj.com, 5 Oct 2005 [Full text]
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