User fees are charges at the point of use for any aspect of health services. Due to scant financial resources, many low and middle-income countries decided to introduce them to raise additional revenue. It was argued that they would help reduce ‘frivolous’ consumption of health services, and increase the quality of services and equity of consumption through the resources they would yield. User fees are charges levied at the point of use for any aspect of health services: registration fee, consultation fee, fees for drugs and medical supplies or any health service rendered. Fees can be paid for each visitor can encompass an entire episode of illness. According to its supporters, user fees are supposed to fulfill three objectives: 1) to improve efficiency of use and diminish “frivolous” consumption, 2) to raise revenue to complement traditional funding sources (the public budget) and therefore sometimes allow for improved personnel motivation and service quality, and 3) to improve the equity of distribution of health services in a given country through the reallocation of resources collected through user fees. On the other hand, there are concerns over the implications of user fees for equity in access since utilization can decrease, especially in disadvantaged populations, with an increase in user fees. In addition, user fees are generally regressive - the payment is the same per service regardless of income.

 Lucy Gilson, David Evans, Tracey Perez et al; August 2008