The fund will strengthen health systems and help abolish healthcare user fees for children and women, saving tens of thousands of lives and accelerating progress on the health-related Millennium Development Goals.
Some feel that there is now a consensus on the need to abolish user fees [ 20, 21]: " A consensus is emerging that user fees are not an appropriate financing mechanism for health services in developing countries" [ 20].
In our study, we have noted that different actors are influenced by different types of evidence, the WB relied mostly on formal research as the basis to push for the introduction of user fees, technocrats in the MoH relied mostly on formal research to push for reorganization of user fees while politicians relied mostly on community complaints to abolish user fees.
The timeliness of the evidence also varied; some respondents reported that there was evidence regarding the ills of user fees, and others reported that evidence was generated after the decision to abolish user fees was made.
A MoH respondent stated, "I suspect the pronouncement to abolish user fees was through political pressure and competition because the main opposition party was saying 'we will abolish user fees for health services immediately' so the captain could not say 'I will wait for the plan', they could lose votes".
Moat & Abelson in their analysis of the influence of institutions in the decision to abolish user fees in Uganda, highlighted the weaknesses of government structures to impact on the decision making process to abolish user fees concluding that "Big man" presidentialism and clientelism thwarted the role of formal institutions[ 31].
Next, he took on healthcare – with some of the worst infant mortality rates in the world, Sierra Leone's programme to abolish user fees for children under five and pregnant mothers was an ambitious and impressive programme of reform.
The ultimate aim is to abolish user fees in all primary care facilities [ 24].
A majority of respondents reported that this political window could have provided an opportunity to abolish user fees.
Therefore, it is now urgent to abolish user fees for births because the State has the financial means to do so.
It was as if the decision to abolish user fees, which in itself was difficult to achieve, was enough on its own.
