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The International Association of Chartered Certified Accountants – not always known for their progressive leanings on issues like privatization and user fees – has done an investigation of the effects of user fees on public services in developing countries. Find report at: www.accaglobal.com/doc/publicsector/tech_ips_006.pdf.

Surprise, surprise. The association found that user fees for education and health care led to drastic reductions in those services with wide-ranging negative social effects in developing countries.

The long, sad history of user fees in developing nations is rooted in International Monetary Fund and World Bank structural adjustment programs in the 1980s. The effects of user fees and privatization are long lasting – and for AIDS-ravaged African countries, incredibly harmful. According to the report:

  • · User fees for Kenyan outpatient health centres reduced visits by 52 per cent over several years.
  • · The introduction of user fees in Papua New Guinea caused a 30 per cent reduction in outpatient visits.
  • · In 1985, Ghana brought in a health insurance scheme that required Ghanaians to pay monthly fees for health care. The income raised by the fees barely covered 15 per cent of the administrative costs, which are typically high for such schemes.
  • · Tanzania followed Kenya’s policy on outpatient services and has left an underserved and angered public with no services.
  • · When Kenya abolished user fees for health care, visits to outpatient centres rose by 41 per cent.