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The impact of user fee exemption on service utilization and treatment seeking behaviour: the case of malaria in Sudan
Author(s) -
Abdu Zeidan,
Mohammed Zakariya,
Bashier Ilham,
Eriksson Bo
Publication year - 2004
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.777
Subject(s) - user fee , malaria , service (business) , business , fee for service , public economics , economics , marketing , medicine , political science , economic growth , law , immunology , health care
This experimental study was undertaken to assess the effect of different levels of exemption, 25%, 50% and 75%, from health centre user fees on health service utilization and treatment seeking behaviour for malaria by a high risk group of pregnant women and children under 5 years. These are groups in need of special medical attention to prevent progression of the disease into complicated or severe malaria. Sinnar State, one of Sudan's highly endemic malaria regions, was selected to be the experimental area. Exemptions were introduced for one year in six health centres. Two centres for each exemption level, and a further two health centres without exemptions were studied. At the beginning and the end of the trial year, households surveys were conducted in the catchment areas of the health centres, and focus group discussions with pregnant women and mothers of children under 5 years were conducted. Routine data were reviewed for malaria cases in the health centres and six studies on malaria cases were done upon exit from the health centres. In‐depth interviews with health staff of the health centres were conducted. Exemption from user fees increased health services utilization, improved treatment‐seeking behaviour and promoted early diagnosis. The changes during the experimental year were the largest in the centres with the largest exemption. Therefore, policy changes towards exemptions are necessary to facilitate early diagnosis and treatment of malaria. Copyright © 2004 John Wiley & Sons, Ltd.