Frank Nyonator|Joseph Kutzin
Health for Some? The Effects of User Fees in the Volta Region of Ghana
Ministry of Health
paper reports key findings conclusions 1996 study user fees exemptions volta region ghana variety data sources methods used including interviews patients managers communitybased focus group discussions analysis facility records analyses previous household survey data official fee levels exemption categories established 1985 legislation made provision drug fees cost thus revised line inflation official fees adjusted since 1985 face declining real levels budget allocations decreased supplies essential consumables central medical stores facility managers established pricing fee collection systems allowed ministry health decentralized nature fee setting collection practices made difficult ministry monitor effects fees study found facility managers active setting collecting fees using revenues purchase essential inputs level revenues mobilized accounts twothirds fourfifths nonsalary operating budget government health facilities virtually resources nonsalary operating expenses mission hospitals official exemptions largely nonfunctional less one 1000 patient contacts granted exemption 1995 estimates 15 30 population lives poverty failure exemptions function means fees preventing access poor imposing significant financial hardships part population health facilities volta region achieved kind sustainable inequity fees enabling service provision continue concurrently preventing part population using services