District managers agreed that officially only the national Ministry of Health could set user fee levels, but said that if a facility had extra needs, and the community agreed, the DHMT would allow higher fees.
It was introduced in response to a reduction in user fee levels in 2004, which significantly reduced facility income, and was argued to have undermined the relationship between committee members and communities ([ 14, 15]).
This service price depends on the investments and agreed performance levels, rather than on the user fee level, and which provides the private sector with the financial risks.
Although there have been attempts towards lowering the user fees at lower level facilities (community dispensaries and health centres), this has not been effected at district hospital level.
The coefficients for user fee subsidisation (level and slope) obtained from the interrupted time series regression analyses were also used to model outcomes at one and 24 months after the introduction of subsidisation, and compared to counterfactual outcomes (i.e. the projected outcomes in the absence of an intervention) as described previously by Lagarde et al. [ 7].
The public funding of the government health sector would then need to be dramatically increased so as to make the abolition of user fees at facility level (again) a reality.
At individual level, user fees are the main barriers to adherence to ART [ 55].
Implementation of the fund overlapped with the government's decision to remove user fees in all community-level public facilities in the country.
Most of the government funds are earmarked to cover personnel cost ("Nombrados" and "Contratados" type of contract) and pharmaceuticals, while facility level user fees can be used more flexibly [ 15].
User fees in public lower level facilities were introduced alongside the CHF, along with a system of exemptions (free care for priority population groups (e.g., children under five, pregnant women) and waivers (free care to those who are unable to pay).
